Your Health Care: Who Decides?


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No one can predict when a serious illness or accident might occur. When it does, a patient may need someone else to speak or make healthcare decisions for him or her. By planning now, a person can increase the chances that the medical treatment he or she get will be the treatment they want.

To help with this process, Advocate Health Care has initiated a program to train associates in the techniques of advance care planning, an approach to planning in advance for future healthcare. Advance Care Planning (ACP) helps reshape the patient/health professional relationship and how decisions are made when patients have life-threatening medical problems from which they are unlikely to recover, however their life might be extended by medical treatment.

ACP across Advocate focuses on two activities: The first involves thinking and talking about health care decisions, and who the patient would like to make those decisions in the event he or she is unable to do so. The second concentrates on the completion of Advance Directive forms, which specify how these decisions are to be carried out.

ACP facilitators help patients define for themselves acceptable functional outcomes and treatments at each stage of his or her illness. ACP requires dedicated time and special preparation, and the process should begin promptly with outpatients who have congestive heart failure, cancer, or other potentially life-threatening illnesses, and with those who have progressive mental deterioration. The full process might span several visits at which the facilitator helps patients (and hopefully their proxy decision maker) understand, reflect, and discuss their goals and values about the patient’s health care, and preferences for future medical interventions. Over time, as a patient’s illness experience evolves, these discussions are revisited to see if the person’s preferences for health care have changed.

The second step is to accurately record the patient’s preferences in an ADVANCE DIRECTIVE (AD) document. By signing these legal documents, patients can request or refuse specific treatments and can choose proxies or decision makers for times when the patient is unable to make healthcare decisions for him or herself.

    The most common AD forms in Illinois are:

  • The Power of Attorney for Health Care
  • The Living Will
  • Illinois POLST form (Practitioner Orders for Life Sustaining Treatment)

These documents are recognized by state law as constituting evidence of an individual’s health care wishes, stated in advance of an inability to make decisions. They take effect only when the person is deemed to have lost capacity to make health care decisions. Chaplains, ACP facilitators, and other members of the health care team are frequently called upon to answer patient and family questions about these forms.

The ADVANCE CARE PLANNING process—the combination of understanding, reflecting on, and discussing values and preferences about healthcare treatment, plus the completion of written ADVANCE DIRECTIVES to guide future care—is evidence of Advocate Health Care’s commitment to its mission, values, and philosophy.