Medical Decision Making

1. Anchor medical decisions within a solid moral framework which recognizes the inherent worth of every human person, regardless or his or her functional capacity, health status, or degree of illness or disability. Honor yourself and others as human beings, rather than human doings. Know that you are much more than the sum or your functional working parts. Never intentionally hasten death and never feel obliged to prolong life at its end.

2. Discuss your perceptions, thoughts, and feelings about potential medical decision-making with your loved ones. Know that it is difficult to anticipate in advance how you might feel or what specific care or treatment you might want or not want at some date in the future. In an emergency, it's usually it's best to err on the side of life-affirming care until the exact medical situation can be clarified and potential care and treatment options outlined. (See POLST form booklet for examples of when aggressive emergency care and resuscitation might not be in your best interests.)

3. Choose a loved one, trusted decision-maker, or health care proxy (someone to represent you in decision-making) in case you become incapacitated. Make sure this person's philosophy of life and care is compatible with your own and that he or she will be a strong advocate for you, able to understand concrete medical situations, and discern, with help, which care choices are best in a particular medical circumstance.

4. Complete a Durable Power of Attorney for Health Care form. (Also called 'DPOH-HC, Power of Attorney for Health Care' and an 'Attorney in Fact.') Execute the Durable Power of Attorney for Health Care form with the assistance of your health care proxy and/or an attorney or notary public. Make certain the document is properly signed and witnessed and/or notarized, and that it is legal in the state where you live.

5. Be cautious about completing a Living Will. If you do complete a Living Will, make sure it gives your Power of Attorney for Health Care (also known as "attorney in fact") primary decision-making capacity. If a situation is 'murky' in terms of 'what you would have wanted,' your health care proxy has the legal power to confer with your health care providers and choose care and treatment options on your behalf.

6. If you are seriously or terminally ill or of an advanced age and do not want cardio-pulmonary resuscitation (CPR), you may want to discuss completing a POLST form with your health care proxy and your physician. Your choice depends on your health status at the time and whether resuscitation will have a relatively good chance of succeeding or not. In some states, medics responding to a 911 call (even for a dying hospice patient) are only permitted to withhold CPR if there is a signed POLST form in the home. While most healthy people should be resuscitated, it is morally permissible to choose No CPR in many medical situations. Ordinary treatment-including antibiotics, food and water-are usually considered normal care unless the person is unable to assimilate food, fluids, or medication, and/or these prove to be unhelpful or harmful. Note: at the end of life, when a person’s vital systems are shutting down, it is not a comfort measure to administer food and fluids.

7. Tell your loved ones where to find important documents, such as your will, power of attorney, durable power of attorney, living will, POLST form, and any other essential financial, social, or personal information. Make sure your physician has a copy of your Durable Power of Attorney (DPOA-HC) and other important medical decision-making forms.

8. Address unfinished personal and family business. Begin heartfelt conversations with your children, spouse, loved ones, or friends. Say the Four Best Things: "Thank you," "Please forgive me," "I forgive you," and "I love you." Write letters or cards to loved ones. Leave a legacy of wisdom, life experience, faith, hope, and love.

9. When the time comes, allow yourself to be cared for. Know that you aren't a burden, but a blessing. Caring for you is an honor and a privilege, even when it is difficult and heart-breaking for your loved ones. Your loved ones can't make you better, though they wish they could. But in allowing them to care for you, you give them the gift of knowing they did all they could on your behalf. This will help them weather the grief they will endure after your passing. Encourage your loved ones by saying "yes" to care giving help, respite, and assistance.

10. Anticipating and dealing with medical and personal decisions now can go a long way towards preventing family and relationship ruptures later. Take a step. Begin the conversation. You'll likely be glad you did. So will your loved ones.