Planning for the future can be challenging, especially if it is about your healthcare.  You can start by thinking about what kind of treatments you would or would not want in a medical emergency. See discussions regarding “Planning for future care in advance” in our past blogs about this. It might help to talk with your doctor about how your present health conditions including kidney disease might influence your health in the future. For example, what would happen if you had to go on dialysis or if your high blood pressure leads to a stroke?  Your family medical history might be a clue to thinking about the future.  If you develop health problems similar to those of other family members you may plan ahead and be ready.

Your personal values are key in the decision making process. Is your main desire to have the most days of life, or to have the most life in your days? What if an illness leaves you bed bound or paralyzed or in a coma and you need to be on a ventilator? What would life be like then? What makes life meaningful to you and what would you want at the end? You might want doctors to try CPR if your heart stops or to try using a ventilator for a short time if the illness is reversible or there is hope for meaningful recovery, or if that means that in the future you could be well enough to spend time with your family. Along the way you have to ask yourself many difficult questions but answers become easier if you keep your family values in mind.

For some people, staying alive as long as medically possible is the most important thing. An advance directive can help make sure that happens. Your decisions about how to handle any of the unforeseen situations could be different at age 40 than at age 80. Or they could be different if you have an untreatable condition as opposed to being generally healthy. An advance directive allows you to provide instructions for these types of situations and then to change the instructions as you get older or if your viewpoint changes.

To plan you need to prepare legal documents for an advance directive. Talk with your doctor about your wishes and your doctor can guide you to make the right decision and provide you with forms necessary to prepare for your future health. These documents include living will, durable power of attorney for health care, and other documents discussing DNR (do not resuscitate) orders, dialysis, and blood transfusions.

A living will is a written document that helps you tell doctors how you want to be treated if you are dying or permanently unconscious and cannot make decisions about emergency treatment. In a living will, you can say which of the procedures you would want, which ones you wouldn’t want, and under which conditions each of your choices applies.  

A durable power of attorney for health care assign a healthcare proxy, someone to make medical decisions for you at times when you might not be able to do so. Your proxy, also known as a surrogate or agent, should be familiar with your values and wishes. This means that he or she will be able to decide as you would when treatment decisions need to be made. A proxy can be chosen in addition to or instead of a living will. Having a healthcare proxy helps you plan for situations that cannot be foreseen, like a serious auto accident. A durable power of attorney for health care enables you to be more specific about your medical treatment than a living will. Some people prefer naming a healthcare agent to make decisions on their behalf; especially if there is someone they feel comfortable talking with about their values and preferences.

An advance care planning form known as POLST (Physician Orders for Life-Sustaining Treatment) or MOLST (Medical Orders for Life-Sustaining Treatment) has been developed by many states. These forms serve in addition to your advance directive. They make it possible for you to provide more detailed guidance about your medical care preferences in an obvious format. Your doctor will talk with you and your family for guidance, but the form is filled out by the doctor or, sometimes, a nurse practitioner or physician’s assistant who also signs the form. Once signed this form has the force of any other medical order. To set them apart these forms are often printed on brightly colored paper so they are easily found in a medical or hospital file. Check with your state health department to find out if this form is available where you live. In California this form is available here.

You should let key people know that you have an advance directive. Give copies to your doctors and healthcare proxy and alternate proxy. Tell important family members and friends where you keep a copy. If you have to go to the hospital they will ask you for a copy. Because you might change your advance directive in the future, it’s a good idea to keep track of who receives a copy.