Post Terminal Prognosis: Topic No. 5 (Part 2 of 2) – Pre-Planning for Funeral/Burial and EOL Care

While a living will or other documents may be in place, the following forms will enable you to provide emergency and/or medical personnel with a more concise and clear understanding of the TiLOs wishes should he/she be unable to communicate.  Please make sure that the stated wishes of the TiLO are consistent with the content of the living will, should such a document exist.  This will help to minimize any confusion should an emergency situation arise and the TiLO is unable to communicate.

In addition, as part of this process, it will also be very important to appoint a trusted individual to act on behalf of the TiLO with respect to health care related matters should the TiLO be unable to communicate.  I have included a link to the California Advance Health Care Directive to be used for the purpose of appointing this individual.  This person will be authorized to act on the TiLO’s behalf in making medical decisions that may not be covered in the DNR, POLST or even the living will, again, if such a document is in place.

For instance, while caring for my terminally ill father, his condition suddenly changed for the worse and he lost all of his ability to speak.  Fortunately, we had executed all of the aforementioned documents within a month of his terminal prognosis, and I was able to communicate my dying father’s wishes with the medical care team and hospice during his final seven days.  Once he passed, I made a phone call to the funeral home and they came to pick up his remains.  By having all of the above essential items in place earlier on in the process, we could really focus on living and making the most of each day, maximizing his quality of life.  Having the above items in place also enabled me to take my father on a 10-day 3,200-mile roundtrip back to his hometown.

Key EOL Documents

As for documents that should be put in place, if such documents are not already in place as part of any end-of-life (EOL) planning that may have taken place prior to the terminal prognosis being issued, please consult with legal counsel as the requirements may be different in each state or, if applicable, country. in addition to the documents (i.e. Medical DNR, Medical Power of Attorney, etc.),

Prehospital DNR Form

The Prehospital Do Not Resuscitate (DNR) Form is an official State document developed by the California EMS Authority, in concert with the California Medical Association and emergency medical services (EMS) providers, for the purpose of instructing EMS personnel regarding a patient’s decision to forgo resuscitative measures in the event of cardioplumonary arrest…a heart attack.

Resusciative measures to be withheld include chest compressions (CPR), assisted ventilation (breathing), endotracheal intubation, defibrillation, and cardiotonic drugs (drugs which stimulate the heart).  The form does not affect the provision of life sustaining measure such as artificial nutrition or hydration or the provisions of other emergency medical care, including treatment for pain, difficulty breathing, major bleeding, or other medical conditions.

The DNR must be signed by the patient or by the patient’s legally recognized health care decisionmaker if the patient is unable to make or communicate informed health care decisions.  The patient’s physician must also sign the form, affirming that the patient/legally recognized health care decisionmaker has given informed consent to the DNR instruction. The DNR form should be clearly posted or maintained near the patient at all times, whether at home, in the hospital, a nursing care facility, a hospice facility, or even while traveling away from any of these places.

DNR Form: CA DNR Form

Physician’s Order for Life Sustaining Treatment (POLST)

The Physician’s Order for Life Sustaining Treatment (POLST) form is approved by the Emergency Medical Services Authority (EMSA) and the Commission on EMS, and developed by the Coalition for Compassionate Care of California.  The POLST form is a medical order that gives seriously ill patients more control over their care by specifying the type of medical treatment a patient wishes to receive at the end of life.  The EMSA approved POLST form must be signed and dated by a physician, or a nurse practitioner or a physician assistant acting under the supervision of the physician, and the patient or legally recognized health care decisionmaker.  The POLST form should be clearly posted or maintained near the patient at all times, just like the executed DNR form.

Physician Orders for Life-Sustaining Treatment (POLST): POLST_2017_Final

Advance Health Care Directive (a.k.a. Durable Medical Power of Attorney)

“Advance directives are important tools for anyone to have, because even the healthiest person could experience a sudden accident and not be able to speak for herself. But when you have a life-threatening illness, it’s particularly critical to make clear, in writing, what your wishes are should the time come when you can’t express them yourself,” per WebMD.

Advance Health Care Directive Form: California Advance Health Care Directive

Should you wish to see some additional helpful information with respect to these critical EOL forms, please see the following WebMD link: https://www.webmd.com/palliative-care/advance-directives-medical-power-attorney

As a final note, once again, the sooner that the pre-planning for the funeral and burial arrangements are completed all the better.  The same can be said for the EOL related documents that I have covered in this latest blog post.

Remember, “I am not giving up, we just need to prepare for every possible outcome.”

As always, great big hugs to one and all!!! ❤ ❤ ❤

~D. Toru White~

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