Advance Care Planning - Advanced Lung Disease: Smoking Cessation

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Advance care planning

The course of COPD is unpredictable. It isn't possible for your doctor to tell you exactly how your illness will progress or what complications you will have. Amid this uncertainty, you owe it to yourself to do what you can to have control over your care, especially at the end of life. So, while you are still able to think clearly and make decisions, sit down with your doctor and your family and consider your options. Then document your wishes in an advance directive.

No one finds this subject easy to talk about; the hardest part is bringing it up. One way to break the ice is to think of advance care planning not as a single conversation but rather a series of small talks, some with your doctor and others with your family, in which you gather information gradually and let your thoughts evolve. You might start by asking your doctor some questions about what might happen. For example, what might happen if you develop pneumonia — how would it be treated? What if you are unable to breathe without a ventilator? Under what circumstances might a ventilator be a temporary aid to help you resume an independent life? Under what circumstances would you have little chance of recovering enough to be off a ventilator? When might hospice care be an option?

As your thoughts crystallize, discuss them with your spouse or other people close to you. Choose one of these people to be your surrogate, or health care proxy — someone who understands your wishes and has the legal power to make decisions about your care should you become unconscious or too sick to communicate. The legal document you will need to name your surrogate is either a durable power of attorney or a health care proxy.

In addition, prepare a living will or similar legal document that states your wishes for treatment at the end of life. A living will usually states that you want to be allowed to die free of pain and aggressive treatment if it is clear that death is inevitable and there is no reasonable chance for recovery. You can also make specific requests concerning whether you wish to be put on a respirator or to be resuscitated if you stop breathing or your heart stops beating. The U.S. Living Will Registry provides living will documents free of charge; to get a copy, call 800-LIV-WILL (800-548-9455). Living wills are legal in all but 12 states; those 12 states require that you either use their own forms or follow other instructions.

All this information is a lot to absorb. One thing that can make the process easier is knowing that you have the legal right to change your advance directive. The more specific you can be in expressing your wishes, the better off you and your family will be.

Last updated:	May 23, 2007