Advance care planning for all ages

Daughter and father discussion

Many of us avoid advance care planning because it is hard to imagine ourselves in a vulnerable situation and we’re fearful of giving up control of our care. But developing an advance care plan is actually about taking control.

This is especially true for people diagnosed with a neurological disorder, such as Alzheimer’s or Parkinson’s disease—but is also true for people at higher risk of severe disease from COVID-19, people with physically dangerous occupations, or anyone occasionally tempted to text and drive.

Losing the ability to make decisions for ourselves is scary. It’s also upsetting to think people might make decisions at odds with how we would like to be cared for—especially well-meaning choices that may end up causing us to suffer.

The best first step is to talk with your family about your wishes and preferences for your care during a serious medical incident or end-of-life care. This is not easy, but if you fail to create an advance care plan, you leave all the decisions to your family members or doctors.

Few of us want to burden our families with difficult or controversial decisions during times of emotional distress. By creating an advance care directive document and designating the person you would like to carry out your wishes, you make those decisions for yourself while you are able.

Questions to think about and discuss

  • How do I want to be treated in my last days?
  • Do I want to receive life-extending care even if it means causing pain for myself or anguish for my family?
  • If I don’t want extraordinary measures taken to extend my life, how do I make that clear to my family and my doctor?

These are sensitive and emotional questions to consider. But now is the time to empower yourself. Clarify and document your end-of-life wishes with an advance care plan. Make copies of that plan and designate someone you love and trust to stand up for you when you no longer can.

Talking with a professional and your loved ones at the same time can make it a little easier. Collaborative care nurses on each Primary Care team can help you talk it through, so give them a call at 603-354-6760.

Everyone should have an advance directive on file. When I work with patients, many people are unsure of what to include in a living will—the types of scenarios and options to consider, and their possible repercussions. Collaborative care nurses are all experienced with these conversations. We can guide your conversation to ensure your values guide your care.

Lori Guyette, RN, collaborative care nurse

Frequently asked questions of Advance Care Planning

What is an advance directive?

There are two parts to the New Hampshire advance directive: a durable power of attorney for healthcare and a living will. You do not need an attorney to complete an advance directive.

A durable power of attorney for healthcare (DPOAHC) document in which you name someone who will make medical decisions with your healthcare team on your behalf if you cannot. The person you choose becomes your "healthcare agent" or "proxy."

A living will documents your written wishes about life-sustaining treatments if you are permanently unconscious or terminally ill and unable to speak for yourself.

What is a Do Not Resuscitate (DNR) order?

A DNR order is different than an advance directive. A DNR is a medical order that specifies your wishes in the event that your heart stops. A DNR order expresses these wishes in your medical chart when you are in the hospital. A DNR order must be written in your medical chart by a physician or nurse practitioner.

Will my healthcare provider know that I have an advance directive?

No, you must tell your healthcare provider. If you are a patient at Cheshire Medical Center, your Primary Care team’s collaborative care nurse can help keep your advance directive on file in myDH.

To whom should I give copies?

You should give copies of your advance directive to your:

  • Healthcare providers
  • Electronic medical records
  • Family
  • Person chosen to be your healthcare agent

You should also keep the original copy with your other important documents.

What if I change my mind?

You can change your advance directives at any time by destroying your current copy and filling out a new form. You should notify your healthcare provider and your DPOAHC (durable power of attorney for healthcare) to make sure they are aware of your changes and provide them with new updated copies.

Where can I learn more?

Beyond calling your Primary Care team's collaborative care nurse at 603-354-6760, you can find more information at the Honoring Care Decisions section of the Dartmouth Hitchcock Medical Center and Dartmouth Hitchcock Clinics website.