Advance Health Care Planning
Palliative care and pain relief are accepted as Human Rights under the Right to Health. However, when we experience serious illness or an accident that may result in admission to the Intensive Care Unit we are sometimes not able to ask for better pain management or other care needs.
The 16th April is advance healthcare planning day.
What is advance healthcare planning?
We plan for important life events, for our baby’s birth, for our wedding, for our retirement. Financial planning for retirement is important so that we don’t face financial hardship in old age. We need to start saving for retirement while we are still young and fit. In the same way, even while we are still young and healthy, we should start thinking about our future health needs. This is not easy as it is hard to imagine that one day we won’t be young and healthy; and talking about death, dying, pain and distress and other end of life issues is a taboo in our society.
Having a discussion about our wishes and preferences for our care if we experience serious illness or injury may be difficult to start but it is something that many people have found very rewarding. The Conversation Project in the USA has put together important facts and stories to help people who have this conversation. http://theconversationproject.org/. Ellen Goodman the founder of the Conversation Project makes the point that “it is always too soon to have the conversation until it’s too late.”
Advance healthcare planning has evolved from the Living Will and from an advance directive. An advance healthcare plan documents our wishes and preferences for care including pain management options and provides an opportunity to discuss these with our family and doctor before we face the crisis of serious illness. Most people will be able to be involved in decisions about their own health care but sometimes serious illness robs us of this ability and it is important that our family and our doctor has guidance on our preferences as they make important decisions about our treatment.
HPCA Advance Healthcare Planning document
The Hospice Palliative Care Association of South Africa encourage people to talk with their family and their doctor about their own choices and preferences in the event of experiencing serious illness or injury; and have a guidance document to help write down these choices. The advance healthcare plan includes the option for effective pain relief and measures so that I am comfortable. This plan should be reviewed and updated as our wishes may change as our circumstances change.
Download the advance healthcare planning document from the HPCA website at http://www.hpca.co.za/images/HealthCarePlanning/HPCAHealthCarePlanning2017.pdf
Why do we need an Advance Health Care Plan?
Medical knowledge and technology has developed to such a degree that there are treatment possibilities that can prolong life and delay death. Often these treatments are important so that the body can recover from a sudden injury or illness and with life-saving treatment, a person can survive and recover his or her health. Sometimes the illness or injury results in disabilities and restrictions to a person’s physical or mental function and he or she needs to adapt to a new reality and may be dependent on others for day-to-day activities. People are wonderfully adaptable and often find that they have good quality of life in spite of their changed state of health and ability to do different things. At other times the disease or injury is so great that even modern medical treatments cannot improve the situation to an acceptable level. However, because doctors are well trained in providing treatments and interventions, these treatments that may not provide any benefit to the patient – termed ‘futile’ treatment – are started and the patient is kept alive rather than allowing a peaceful and natural death.
How can palliative care help at the end of our life?
Palliative care can relieve pain and other distressing symptoms, provides emotional, social and spiritual support to patients and families; and help families care for a loved one with illness or injury so that this care can be provided in the home. We can choose to die at home in familiar circumstances and with the people we love close to us. Palliative care can help this to be a peaceful and comfortable death without pain; being able to speak to our friends and family without confusion, although this also depends on the disease or injury. Hospice nurses and other carers will visit a patient’s home to make sure he or she receives good clinical care at home and will also support the family with bereavement care once the patient dies.
What are YOUR choices?
The HPCA advance healthcare planning document suggests a number of things to consider before documenting wishes for care in the event of serious illness.
Many countries require doctors to help their patients have these discussions as part of the medical consultation. South Africa has decided to encourage this as well. Download the document and discuss it with your family and your doctor.