Making Your Wishes Know About Goals of Care, Especially at the End of Life
It is best to make your wishes known to your loved ones before the stress of an illness or hospitalization occurs. However, if you become ill, you are the decision-maker with the support of your family and the healthcare team.
If you become unable to express your healthcare wishes, an "advanced care plan" can communicate on your behalf. An advanced care plan can take two forms: an explanation of your wishes written on paper (also called an Advanced Directive or a Living Will); or a Power of Attorney for Personal Care, which explains who will convey your wishes to the healthcare team. They can be difficult to write precisely. Here are some online resources available.
One good place to start is the national campaign Speak Up
which organizes National Advance Care Planning Day (April 16). Visti Speak Up online at: www.advancecareplanning.ca
The Ministry of the Attorney General of Ontario has information and forms to help as well, including:
Powers of Attorney
Even if you do not write anything down, try to have some open discussions with those who will be your decision makers if you are too ill to make them for yourself. There is a legal framework in Ontario to decide who makes healthcare decisions on behalf of another—it’s all in the Health Care Consent Act, 1996
. You can appoint a specific Power of Attorney for Personal Care—the Act recognizes this. We can give you more information if you wish.
Plan for End of Life Care. It can unfortunately be needed any time.
It rarely feels like the right time to talk about end-of-life plans, but the best time is when there’s no crisis. We should all discuss our end-of-life care plan with our loved ones and our healthcare providers.
These are tough conversations that take a lot of thinking and some courage. Let your family, friends and caregivers support you. Discuss your wishes in the event that a decision needs to be made pertaining to your end of life care.
What is CPR?
Cardiopulmonary resuscitation (CPR) is an emergency procedure which is performed when a person stops breathing or their heart stops beating. It includes mouth-to-mouth breathing (artificial respiration) and chest compressions to manually restart heart pumping from outside of the body (artificial circulation).
In the hospital, CPR may lead to other treatments, such as medication or electric shock (defibrillation) to restart the heart, and tubes or machines (intubation) to help a person breathe. If successful, CPR restores both breathing and heartbeat.
Does CPR Work?
CPR was intended for use in emergency situations to treat sudden, unexpected death in otherwise healthy people due to heart attack or drowning.
CPR was not intended for people who are terminally ill, who have very complex diseases, or those with progressive degenerative diseases. There is little evidence that CPR will benefit these people.
Talk with your family and healthcare team about your feelings toward CPR. Ask your healthcare team about your condition and whether CPR would be a suitable treatment for you.
Make your wishes known
A "No CPR" order means that if no signs of life are present, nature is allowed to take its course and no medical intervention is made in an effort to prolong the person's life.
"No CPR" order still means full supportive care. Should you request a "No CPR" order, full medical, nursing and supportive care will continue during your stay to ensure you are kept comfortable and without pain or other unpleasant symptoms. In addition, some lab work and tests may continue to be done to monitor and determine whether or not there are any further treatment needs and/or options.
If further treatment options become available, you can always change your mind or cancel the "No CPR" order at any time.