May 26th, 2019

Advance care planningis essential


By Lethbridge Herald Opinon on May 4, 2019.

Dr. Daren Heyland

Critical Care Physician

The article entitled “Plan now for end-of-life issues” by David Amies (April 26) is a welcome reminder that we are all immortal and need to plan for the eventuality of our death.

I think some readers may not see the relevance of this message in their own lives. Most of us feel like we are not near to or needing to plan our death. However, advance care planning for death is not the same as advance care planning for serious illness and I am afraid that the article perpetuates this misunderstanding.

Our research shows most citizens fail to engage in advance care planning because they think it is restricted to planning for terminal end-of-life care. Some don’t want to talk about death and dying or they think they are “not sick enough,” so it is not relevant to them.

However, advance care planning for serious illness is a different matter. Serious illness, such as a major stroke or heart attack, or being involved in a major accident, can strike any of us at any given moment – the young and the old, the healthy and the frail. Serious illness can result in death but people can also recover from it.

Under these conditions of “uncertainty,” where we don’t know the outcome, it becomes challenging to plan for future medical care. With the exception the few who are actively in the dying process, for most Albertans, filling out an AHS “Goals of Care Designation Form” and placing it in their green sleeve constitutes advance care planning for serious illness. This form dictates the nature of care you will receive when you present with a serious illness and can only be filled out after a discussion with a doctor.

Of course, doctors and other clinicians will always try and speak to you when seriously ill, explain to you what is going on, and involve you in decision making. But the harsh reality is that most people, when seriously ill, will be unable to think clearly and often unable to speak and, thus, unable to participate in decision making.

In these situations, doctors will turn to surrounding family members or designated surrogate decision makers to make life and death decisions. Too often, I have observed families experience significant stress and anxiety trying to make decisions for their seriously ill loved one when they don’t know the patient’s wishes or preferences.

So, whereas not everyone may feel motivated to plan in advance for their death (under conditions of certainty), everyone should do themselves and their family members a favour and plan in advance for serous illness. Tools exist to help plan for serious illness in a way that enables them to interact with their doctors with more confidence and to be sure that they get the medical treatments that are right for them.

An example of such a tool is the Plan Well Guide which was mostly developed here in Lethbridge with lots of input from patients and doctors in town (See http://www.planwellguide.com).

Dr. Daren K. Heyland is Professor of Medicine at Queen’s University

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