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Advance care planning is making decisions about the care you would want to receive if you became unable to speak for yourself. These are your decisions to make, regardless of the choice for care. These decisions are based on your own personal values, beliefs and preferences. Part of the planning process is to share your wishes with your family, friends and medical providers.
Accidents and sudden severe illness do not discriminate and can happen to people of all ages. In Colorado, it is particularly important to have someone designated - in writing - as your medical health care agent. Your Medical Durable Power of Attorney is the document that allows your representative to make decisions on your behalf if you cannot. Every day people arrive in the emergency rooms of hospitals unable to communicate. In these situations, having advance directives ensures that your doctor knows your wishes about the kind of treatment you want, as well as the person you choose to make medical decisions on your behalf. We recommend that any legal-aged adult have a completed advance care plan.
Advance directives document your health-care wishes and are used if you are unable to communicate for yourself. The most common directives include:
| Advanced Directive Type | Definition | Pros | Cons | Comments |
|---|---|---|---|---|
| Medical Durable Power of Attorney | Agent appointed by patient to make decisions when patient lacks capacity, temporarily or permanently. (Agent with general POA has no medical decision-making authority) | Agent has broad range of authority to respond to situation at hand according to the patient values. | Patient must have shared values with agent. Only for healthcare decisions. Patient can fire agent - even if lacks decisional capacity. | Agent has latitude in making medical decisions; most adaptable way for patient wishes to be expressed. Cannot override LW, CPR directive. |
| Living Will | Person directs withdrawal of life-sustaining treatments when s/he lacks capacity and in terminal or persistent vegetative state | Must be honored unless a MDPOA is given express authority to override. | Only in effect when patient lacks DMC and in terminal condition or PVS as determined by two doctors | Very narrow, inflexible. |
| CPR Directive | Colorado state form documenting refusal of CPR in the event person's heart or breathing malfunction | To be honored by all EMS, facilities. | Does not instruct on how much to intervene on other pre-death care, like dialysis, transfusions, and intubation for respiratory distress only. | Order across settings; only effective in cardio-pulmonary arrest. (DNAR order is translation of this during hospital admission.) |
| MOST form (Medical Orders for Scope of Treatment) | Orders (not directives) signed by patient (or representative) and health care provider to determine treatment wishes near the end of life. | Orders (includes copies) are to be fully honored by all providers in all settings in Colorado. | Intended for only patients with chronic, serious or advanced illness. | New form, broader scope than CPR directives. Wishes for wide diversity of treatments can be expressed. |
| Proxy decision maker for health care | Surrogate when patient lacks decisional capacity but hasn't designated an agent (MDPOA). Selected by "interested parties" as person who can best speak for the patient's wishes/best interest. | Provides consent for non-emergent interventions or restraint by representing patient in giving "informed consent." | Family and friends may disagree, causing significant stress. Proxy cannot withhold artificial hydration, nutrition in most instances. Many providers unaware of process for getting proxy in CO. | Less freedom than agent with MDPOA to make medical decisions. |
| Five Wishes | Privately produced legally accepted document executed by patient to express preferences for medical treatment, pre & post-death wishes. | Offers opportunity to express wide range of peri-death wishes. | Procedure based medical wishes; often not useful as guide in clinical care in actual situation. | Wishes are intended to be followed by may be overridden by MDPOA or proxies. |
NO. The Larimer ACP Team can only help individuals with medical directives. If you are looking for resources to help with legal documents like power of attorney, wills, or trusts, please visit our resources page and look under the "Legal" section.
The Larimer Advance Care Planning team guides adults in deciding their wishes for end-of-life care and in documenting those wishes through advance care directives. We want to make advance care planning a part of the continuum of health care for all adults.
It’s time to start talking about dying, time to share the way we want to live at the end of our lives, and it’s time to communicate about the kind of care we want and don’t want for ourselves. Together, we can make these difficult conversations easier. We can work toward making our own wishes and those of our loved ones expressed and respected. If you’re ready to start your conversations and make your wishes for end-of-life care known, let us guide you through the process of advance care planning. The Larimer Advance Care Planning team services are provided at no cost
The Larimer Advance Care Planning team:
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Colorado State University Extension is an equal opportunity provider. Colorado State University does not discriminate on the basis of disability and is committed to providing reasonable accommodations. CSU’s Office of Engagement and Extension ensures meaningful access and equal opportunities to participate to individuals whose first language is not English. Colorado State University Extension es un proveedor que ofrece igualdad de oportunidades.
Colorado State University no discrimina por motivos de discapacidad y se compromete a proporcionar adaptaciones razonables. Office of Engagement and Extension de CSU garantiza acceso significativo e igualdad de oportunidades para participar a las personas quienes su primer idioma no es el inglés.
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