Advance Care Planning

I’m young, I’m healthy, why do I need an Advance Care Plan?

It’s not the sexiest of topics – death and dying – but it is the only certainty in life… we all die.

As a GP obstetrician, who looks after women in pregnancy and supports them to bring life into the world, you may think it a bit strange that I would be talking about documenting end of life wishes rather than birth plans. Don’t get me wrong, birth plans are valuable, and I do discuss them in another blog post, however I feel that Advance Care Planning is a bit of a mystery to many people, and yet an incredibly important process for people to engage in when they are well.

Start the conversation

Advance Care Planning starts with a conversation about what you want your death experience to be like, and how you would like to be cared for when you can no longer communicate your wishes. This conversation might start with your partner or your children, simply considering questions such as;

Where do I want to die?

Who do I want to be with me?

What sort of medical interventions would I want to avoid?

What sort of comfort cares would I like?

What sort of spiritual support will I need?

For many people, they would prefer to die at home, and yet the Australian statistics show that only 14% of people actually do, with 54% dying in hospitals and 32% in residential facilities (Broad et al, 2013).

There are many unknowns when you are planning for the end of life. It can be a challenge considering the many circumstances that may arise, and it can be tempting to just pretend that it will never happen, and focus on living a full and exciting life rather than focussing on our death. Of course, I am a strong supporter of living mindfully and with purpose, but I also believe in the “PPPPPP approach”: prior preparation prevents a piss-poor performance (thanks to my husband Brad for enlightening me to this one!).

Explore resources

The good news is, there are now a range of practical resources available online to the general public that you can access to assist you with contemplating your end of life wishes.

Dying to Talk is an Australian Palliative Care website with a Discussion Starter tool kit that assists you with preparing for end of life discussions, providing tips on how to start the conversation. You can also download or order a set of cards that list a range of values for you to consider and prioritise as very important, somewhat important or not that important, which can also be a helpful planning tool. These resources can be downloaded for free from the website, or you can order hard copies for a $5 per deck of cards.

Where I work in Busselton, Western Australia, we recently ran a free community workshop about Advance Care Planning as part of National Advance Care Planning week. It was very well attended, with lots of requests for support with writing an Advance Health Directive. Those in attendance felt that once they had started the conversation with their loved ones about their values and priorities at end of life, they felt a bit lost with the next step: creating a legal document that will guide their treating health care providers in the event that they are not able to speak for themselves.

Legal documents

There are a number of legal documents that you can complete as part of the Advance Care Planning process. These include;

1. An Advance Health Directive (AHD)

2. An Enduring Power of Guardianship (EPG)

3. An Enduring Power of Attorney (EPA)

4. A Will

The first two documents (AHD and EPG) relate to decisions about your health care, whereas the second two documents (EPA and Will) relate to management of your assets and financial affairs. It is therefore important to consider completing all four of these documents. As with all legal documentation, it is highly recommended that you seek professional advice when you are completing them. Your GP is an excellent resource when completing your AHD and EPG documentation, while a lawyer will be helpful for completing your EPA and your Will.

Further to these legal documents, there is also a document called an Advance Care Plan, which provides a template for you to record details such as where you would like to die, who you would like to be present when you are dying, funeral preferences, etc.

Advance Care Planning Australia is a one-stop shop where you can access each of these forms to download for free. It is important to note that each State in Australia has their own forms and requirements. There are fact sheets available on this site that provide advice on how to complete each form, however if you require further assistance, I would encourage you to make an appointment with your GP who knows your personal and health circumstances and will therefore be able to provide individualised advice.

A conversation won't kill you!

Finally, I would like to reiterate that these conversations won’t kill you! Starting the process of talking about how you would like to die is likely to improve your death experience, not only for you but for your loved ones who may well need to be making decisions about your end of life care on your behalf. Getting clear on what your values and preferences are now, while you are still well, will allow you to focus on what’s really important when the time comes, rather than having to worry about difficult decisions when you are at your most vulnerable.

References:

Broad JB, Gott M, Kim H, et al. 2013. Where do people die? An international comparison of the percentage of deaths occurring in hospital and residential care settings in 45 populations, using published and available statistics. Int J Public Health. 58: 257-267.