End of Life Issues

Online Resources for Caregivers

Resources for people facing life-limiting illness, their families, and their professional caregivers. www.dyingwell.org

Caring Connections, a program of the National Hospice and Palliative Care Organization (NHPCO), is a national consumer and community engagement initiative to improve care at the end of life, supported by a grant from The Robert Wood Johnson Foundation. www.caringinfo.org

The Hospice Organization and Palliative Experts of Wisconsin’s missions is to provide education, legislative influence, and partnership opportunities to all individuals and organizations in the state of Wisconsin who influence quality end-of-life decisions and care to strengthen the provision of hospice and palliative care. www.wisconsinhospice.org

MedlinePlus Health Information from the National Library of Medicine and the National Institutes of Health. www.nlm.nih.gov/medlineplus/advancedirectives.html

Information about the diagnosis of cancer, its treatment, and coping. www.cancer.org

Health information for the whole family. www.familydoctor.org

 

Do Not Resuscitate (DNR)

Resuscitate vs Do Not Resuscitate

View a video about DNR Policies.

Cardiopulmonary Resuscitation (CPR) is a procedure used to revive a person when the heart and/or breathing stops. Originally it was created for reviving healthy people who suffered sudden, unexpected deaths (such as drownings or heart rhythm problems). Today, anyone who has not designated otherwise is presumed to want resuscitation.

Some people who are elderly or who have many medical problems decide they do not want CPR. This does not mean they wish to 'Give Up' or do not want to live. It means that they are willing to accept their death when it is their natural dying time.

Those who decide they do not want to be resuscitated need to have their doctor write an order that will say 'No CPR', 'Do Not Resuscitate', or 'No Code'. A doctor's order is needed to stop CPR. A written statement in a Power of Attorney for Health Care document from the state of Wisconsin or a Living Will will not stop CPR.

In the state of Wisconsin, if a person has a doctor's order for 'no CPR’, they wear a special bracelet while hospitalized. If a person living in the community is certain they do not ever want CPR done, they must wear a specific Community DNR bracelet that is provided by the State of Wisconsin. Plastic hospital-type bracelets are free from community hospitals. Metal bracelets are available through Medic-Alert for a fee.

We can answer questions about resuscitation and can provide information on how to obtain a free plastic Community DNR bracelet or how to purchase a metal Community DNR bracelet from Medic-Alert.

 

Frequently Asked Questions

What is an Advance Directive?
What is the difference between a Living Will and a Power of Attorney for Health Care?
Who should have a Power of Attorney for Health Care?
Why should I have a Power of Attorney for Health Care?
Who should be my agent, or trusted person for my Power of Attorney for Health Care?
Does this go into effect immediately after I sign the Power of Attorney for Health Care document?
How do I get a Power for Attorney? Who can assist me in filling out the Power of Attorney for Health Care?
Do I need a lawyer?
Will my Power of Attorney for Health Care be honored?
Is the Power of Attorney for Health Care good in every state, or only the state I fill it out in?
What do I do with my Power of Attorney for Health Care once it is signed?
If I sign an advance directive, does that mean I will not receive any care?
Do I only need to fill out a Power of Attorney for Health Care once?
How do I start this conversation about end-of-life health care with my healthcare provider?
How do I start this conversation about end-of-life health care with my family?
What if my family disagrees with my wishes?
Will the doctors just talk with my family about my end-of-life care?
What topics should I discuss with my agent, health care provider and family?
There are so many terms I do not understand. Can you explain some of the medical interventions available at end-of-life in the Chippewa Valley?
What topics should I discuss with my agent, health care provider and family?
There are so many terms I do not understand. Can you explain some of the medical interventions available at end-of-life in the Chippewa Valley?

 

What is an Advance Directive?

Advance Directives can be thought of as ‘directions in advance’. You are:

  • choosing the person that will make personal medical decisions for you if you are unable to make decisions for yourself

  • providing that person some direction of your wishes

In the past, the Living Will was used as a document for this purpose. With the medical technology and choices available today, a different document should be used so your legal choices about future care are protected. The Power of Attorney for Health Care (POA-HC) assures you that your voice is heard under any circumstances, even if you cannot communicate with your doctors because of an illness or accident. The POA-HC can also include whether you want to be an organ donor. The POA-HC does not involve financial decisions of any kind.

There is no simple way to outline all the things that might happen in a person's life or to predict what decisions might have to be made in a crisis. You should discuss strongly held values, beliefs, and choices you would make for yourself with the agent you choose. Examples of choices are whether you would want to be kept alive on machines or by a feeding tube, and whether you might want to die at home or elsewhere. It is also important to discuss your values and beliefs with your physicians to make sure they know what you desire for medical care and find out if they would support you in your choices.

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What is the difference between a Living Will and a Power of Attorney for Health Care?

A Living Will allows you to make statements about choices you would want if you had a terminal illness or were in a persistent vegetative state. It directs physicians whether to withhold or withdraw life-sustaining treatment or a feeding tube if you develop an illness or injury that cannot be cured, and your death is imminent. It does not give authority to anyone to make health care decisions on your behalf. For example, if you needed 24 hour/day nursing care in another facility such as a nursing home, a court supervised guardianship and protective placement proceeding would be required. This can be a long and costly process.

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Who should have a Power of Attorney for Health Care?

People age 18 years or older should complete a POA-HC. This document allows you to name a trusted person (agent) to be a ‘voice’ if you become ‘incapacitated’. Incapacity means not being able to think clearly, process information, and tell the doctors what you desire for medical care. Your agent can be a spouse, adult child (over the age of 18), relative, or friend. Once you start having these conversations within your family, why not encourage the entire family to complete an advance directive?

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Why should I have a Power of Attorney for Health Care?

If there is no POA-HC, and there is uncertainty or conflict about what should be done, physicians may ask the courts to appoint a guardian to make decisions for you. This is time consuming, costly, and adds more stress to loved ones who are already overwhelmed. If you do not complete a POA-HC, there is a chance you will not receive the care you would want, or you may receive more treatments than you wish.

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Who should be my agent, or trusted person, for my Power of Attorney for Health Care?

Your agent should be someone you trust who is 18 or older. This person can be a family member or trusted friend. Your agent should be someone who knows what your beliefs and values are, who is able to voice them to your healthcare providers, and who can stay calm in a crisis. Your agent does not need to live in your town or be with you to complete a POA-HC. Your agent cannot be your medical provider unless he or she is also a relative. Most importantly, you want a trusted agent who will follow your wishes even if he or she would not make the same personal decision. An alternate agent is named in case the primary one becomes unable or unwilling to speak for you.

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Does this go into effect immediately after I sign the Power of Attorney for Health Care document?

No, there is a two-step process. First, you sign the Power of Attorney for Health Care appointing your agent. This is filed with your healthcare provider. The POA-HC is never used as long as you can think clearly and communicate with others. But without warning, an accident, stroke, or onset of an illness can immediately change the course of anyone’s life, making someone incapable of processing information and making informed decisions.

The POA-HC is only activated when two physicians, or a physician and psychologist examine a person and documents that he or she is incapacitated. There are times when the POA-HC needs to be activated only temporarily. When the person improves, the document is deactivated, and he or she returns to being the decision maker. The important thing is that your autonomy or ‘right to choose’ is protected by naming an agent in case one is needed.

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How do I get a Power of Attorney? Who can assist me in filling out the Power of Attorney for Health Care?

Social Services or Pastoral Care at your local hospital can give you assistance in discussing medical decision-making and completing a POA-HC. If you complete your own, make sure your witnesses are not family members. Do not date it until you sign it in front of your witnesses. You can also get assistance from your clinic, your lawyer, or the local Department on Aging. The Wisconsin form is found here: http://dhfs.wisconsin.gov/forms/AdvDirectives/

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Do I need a lawyer?

This document can be completed independently and free of charge. Some people may prefer to consult with a lawyer along with making personal and financial arrangements.

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Will my Power of Attorney for Health Care be honored?

The Power of Attorney for Health Care is a legal document. If it is completed correctly, it should be honored. Frequent and clear communication between you, your family, and your health care providers prior to a crisis is the best way to avoid any miscommunication that would lead to your wishes not being honored.

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Is the Power of Attorney for Health Care good in every state, or only the state I fill it out in?

The Power of Attorney for Health Care is a legal document, and therefore, should be honored in all 50 states. However, it is recommended that if you spend considerable amount of time in a different state, you fill out that state’s form as well.

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What do I do with my Power of Attorney for Health Care once it is signed?

Once you have correctly completed the form, make several copies. Each of your agents should have a copy as well as your healthcare provider and hospital. Keep the original at home where it is easily accessible.

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If I sign an advance directive, does that mean I will not receive any care?

Signing an advance directive only appoints your agents and specifies that they are empowered to make decisions in the event that you become incapacitated. You will still receive all the care you desire.

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Do I only need to fill out a Power of Attorney for Health Care once?

A Power of Attorney for Health Care (POA-HC) is a legal document that should be reviewed on a regular basis, for instance, at your annual physical. Are your agents still available to serve, has your health status changed, have you communicated any changes in your wishes to your healthcare provider, agents, and family?

A POA-HC need not change unless your wishes change.

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How do I start this conversation about end-of-life health care with my health care provider?

Conversations need to be initiated. Tell your healthcare provider you’d like to discuss your wishes for care. Ask about a POA-HC document if you don’t have one yet. Write down some questions ahead of time and be prepared to discuss what you feel you would want for care if you were seriously ill or at the end of life.

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How do I start this conversation about end-of-life health care with my family?

Conversations about advance directives have often been avoided because issues are brought up that are not easy to talk about. Use circumstances around you to ease into a discussion such as a family member, friend, or neighbor who is facing serious health issues, a news broadcast, or television show. Conversations at home, while difficult, are much easier than in a hospital waiting room at the time of a crisis.
View Case Studies for Conversation Starters

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What if my family disagrees with my wishes?

This is where good communication comes in. Discuss your wishes and values openly and frequently. Choose an agent who will respect and carry out your wishes. Be sure your healthcare provider is very clear about what your wishes are.

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Will the doctors just talk with my family about my
end-of-life care?

No. In Wisconsin, a family member is not automatically authorized to make health care decisions for you. Since the Patient Self-Determination Act of 1990, people need to complete a Power of Attorney for Health Care to appoint a specific person to act as their agent to make healthcare decisions on their behalf.

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What topics should I discuss with my agent, health care provider and family?

View topics to discuss with your health care agent.

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There are so many terms I do not understand. Can you explain some of the medical interventions available at end-of-life in the Chippewa Valley?

Medical Interventions and Food and Fluids at End-of-life.

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What do I need to consider to answer the three specific questions on the Power of Attorney for Health Care form?

There are three specific questions on the form that are meant to help guide your agent in making decisions on your behalf: admission to a nursing home; provision of feeding tubes; and decisions for pregnant women. The questions are only asking if you give your agent authority to make decisions in these areas. It does not ask if you want to go to a nursing home or have feeding tubes. The best answer is ‘yes’. Saying “Yes” to these questions empowers your agent, so he or she can make decisions about your care no matter what the circumstances, without having to apply to the court for guardianship.

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