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2020-08-27-advance-care-planning-yakes.md (1901B)

      1 # Advance Care Planning
      2 
      3 Beth Ann Yakes, MD
      4 
      5 ## Advance directives (AD)
      6 
      7 Advance directives can cross state boundaries.
      8 
      9 TN
     10 - spouse
     11 - adult children
     12 - parents
     13 - siblings
     14 - other interested family/friends
     15 
     16 (this is especially important for commonlaw or other SOs,
     17 that may fall to the bottom of the list if not explicitly denoted in the AD)
     18 
     19 If any part of the AD is not adequate to define your wishes, write it out.
     20 You can attach as many pages as you'd like.
     21 
     22 "If I can eat ice cream AND watch football, keep me alive.
     23 If I can't do one, the other, or both of these, let me die."
     24 
     25 Re tube feeding/IV fluids:
     26 End of life nutrition is very different than what they feel currently when hangry.
     27 Tube feeds often have gnarly adverse effects, e.g. gastroparesis leading to emesis leading to aspiration.
     28 Also, what to do with the output? -> irritation, ulcers, needing debridement, etc.
     29 IV fluids can lead to edema, more need for catheters, etc.
     30 
     31 Re CPR:
     32 The provision to not resuscitate only comes into effect when the quality of life conditions are met.
     33 
     34 (TRIAD study - physicians got the decision to resuscitate wrong ~50% of the time bc they misunderstood AD relative to irreversible conditions)
     35 
     36 
     37 ## Physician orders for scope of tx (POST)
     38 
     39 Take effect immediately upon signing, unlike AD that only come into play when the outlined conditions are met.
     40 E.g. healthy 90yo elects to not receive CPR regardless of reversible or irreversible conditions,
     41 fill out a POST, sign it -> 90yo codes 2 minutes later, do not do CPR.
     42 
     43 Put it on your fridge! Make it easy to find if found down.
     44 
     45 Anyone who comes in from a group home has to have an active POST
     46 (may say do everything, but has to exist).
     47 
     48 Have to be a physician to sign this form.
     49 
     50 OK to provide copies in any requested language,
     51 but most states require the form be in English to be valid,
     52 so that any provider can read it.
     53 
     54 last updated: 2020-08-27