LEWISTOWN - When it comes to planning for end of life, there are many steps people can take to ensure they receive the best care possible, local health care providers say.
Marcia Stewart, director of the case management department at Lewistown Hospital, said most people plan ahead for the times when they may be unable to speak for themselves, including such life events as a sudden illness or accident.
It's important for people to have a guide so doctors and loved ones are able to make decisions for them, Stewart said. Having decisions made gives loved ones peace of mind, she said.
"They're not easy questions to answer and talk about," she said.
Stewart said questions people should ask themselves when planning for end of life include:
What kind of health care is wanted or unwanted?
Who should make decisions for me?
What are my concerns?
Stewart said it's important for people to have an Advance Health Care Directive. According to a presentation by Stewart on such documents, "an Advance Health Care Directive is a written set of instructions expressing your wishes for medical treatment."
An Advance Health Care Directive contains a health care power of attorney and a living will, Stewart said. Under Pennsylvania laws, a person can choose one or both of these options.
A health care power of attorney is a legal document that states who has been chosen to make the medical decisions for that person regarding health care. The chosen person will speak for that person only if he or she is unable to speak for themselves, Stewart said.
"That person can really be anybody over the age of 18," she said.
The person in the document should be someone that is trusted and knows the person they are representing well, so they are able advocate on their behalf, Stewart said.
If a person doesn't have a health care power of attorney, Pennsylvania laws state that any member or members of different classes may act as a representative and make decisions, Stewart said.
This person may be a spouse, adult child, parent, or other family member, she said.
A living will is a legal document that states what the person wants and doesn't want at the end of life.
In Pennsylvania, lawyers are not required in order to set up an Advance Health Care Directive. Additionally, a notary is not required and the document never expires, Stewart said.
However, witnesses do need to be present when establishing an Advance Health Care Directive, Stewart said.
The presentation states that the purpose of witnesses "is to verify that the person signing the declaration is, indeed, that person. Witnesses are not expected to make a competency determination."
Pennsylvania recommends that witnesses not be heirs, creditors or involved in the patient's care so there is no conflict of interest, Stewart said.
Stewart recommends that patients bring their Advance Health Care Directive to Lewistown Hospital with them. It will be put on the patient's inpatient chart so physicians and nursing staff "will know what they want and who is their agent, should they need one," she said.
Lewistown Hospital provides blank Advance Health Care Directive forms that patients can fill out that contain both a health care power of attorney and a living will, Stewart said. Residents can obtain these sheets by calling Lewistown Hospital or visiting its Web site, www.lewistownhospital.org.
Linda Miller, clinical supervisor at Lewistown Hospital's Hospice: The Bridge, said although a living will is substantial, one of the most important things people can do to prepare for end of life is talk about their wishes with their families.
It is advised for people to tell their families what they would like to happen at the end of life, and to be open and honest about it, Miller said.
"It helps your family to know (what you want)," she said.
Miller said any age is a good age to start talking about and planning for end of life.
In the event a close family member passes away, it is a good opportunity to talk to young children about the end of life. Parents should allow their children to go to funerals and viewings to learn about death, Miller said.
"I think that talking about it can take away the fear," she said.
Miller added that faith and spirituality also can be helpful when talking about and dealing with end of life.
Kimberly Manganaro, family practice physician and associate of family medicine at Geisinger Medical Group in Lewistown, said when it comes to end of life planning, everybody has different values, so it's important for them to express their individual wishes to their families.
Manganaro said the advice she would give to healthy patients at any age is to discuss their choices with their families in the event they are unable to make their own decisions.
She also said it's important for people to designate a health care power of attorney.
"That then allows (that) there's a spokesperson on (their) behalf," she said.
In the event a person has a permanent irreversible condition in which there is no hope for recovery and the patient is unable to make his or her own decisions, an Advance Health Care Directive is very useful, Manganaro said. It acts as a guide for family members and helps them feel more comfortable with the decisions they are faced with.
"It really is a valuable thing," she said.
Geisinger provides a publication that explains the directive. Patients are encouraged to bring their directives to Geisinger so a copy can be kept in their medical record, Manganaro said.
Manganaro added that patients are able to change their directives at any time.
One question that often arises when families must make decisions for those who are no longer able to speak for themselves is how long to keep a family member alive if there is no chance they will get better, Manganaro said. In this situation, the goal is to eliminate suffering, she said.
"People have the right to not be put through painful procedures that aren't going to improve their care," she said.
For more information, visit www.nationalhealthcaredecisionsday.org. For more information about Lewistown Hospital's Hospice: The Bridge, call 242-5000.