April 16 Is National Healthcare Decisions Day — Physicians Urged to Discuss End-of-life Wishes With Patients

April 16 is National Healthcare Decisions Day across the United States. This annual event, supported by the California Medical Association (CMA), is a collaborative effort of national, state and community organizations to encourage everyone to discuss their wishes for end-of-life medical care with loved ones and to complete an advance directive with detailed instructions.

Physicians, families, and other healthcare providers continually struggle to interpret the intent of patients who have failed to complete an advance directive. National Healthcare Decisions Day provides a great opportunity for physicians to talk with their patients about important documents that will make their medical treatment wishes clear, if they are incapacitated or face a terminal illness.

In California, a document called an Advance Health Care Directive is the legally recognized format for a living will. A traditional living will only states a patient's desire not to receive life-sustaining treatment if he or she is terminally ill, or permanently unconscious. But an Advance Health Care Directive allows patients to state their wishes about refusing or accepting life-sustaining treatment, in any situation.

"An Advance Health Care Directive completed before you become unable to make decisions yourself assures that your wishes will be followed, and relieves stress on your family, your physician and other healthcare providers," said CMA President James Hinsdale, MD. "Without a directive, many families find themselves in the agonizing position of having to make a decision on how their loved one wishes to be cared for, particularly if there have been no prior discussions with the family."

The Advance Health Care Directive also has replaced the Durable Power of Attorney for Health Care (DPAHC) as the legally recognized document for appointing a health care agent in California. A health care agent, who may also be known as an "attorney-in-fact," has legal authority to make decisions about a patient's medical care if the patient becomes unable to make these decisions.

However, patients who have already executed a DPAHC or a Natural Death Act Declaration do not have to complete a new Advance Health Care Directive unless it has expired or was executed before 1992.

Physicians are also encouraged to discuss Physician Orders for Life-Sustaining Treatment (POLST) with patients, when appropriate. POLST recently became a legally recognized document that is used for patients with a serious illness or whose life expectancy is a year or less. A POLST form outlines a plan of care reflecting the patient's wishes concerning medical treatment and interventions at life's end. POLST complements an advance directive by turning a patient's treatment preferences into actionable medical orders.

For more information, see CMA's Advance Health Care Directive and POLST kits. The kits, available in English and Spanish, include legal forms and wallet identification cards, and answer many of the most frequently asked questions about these issues.

CMA encourages physicians to keep a supply of forms in their office for patient use. Members can purchase Advance Health Care Directive and POLST kits for $5 each at CMA's online bookstore (nonmember price is $6). Members who order 10 or more receive a 30 percent discount and member orders of 500 or more receive an additional discount of 25 percent.