As the hospice social worker you can help ensure patients’ wishes are honored by helping them put advance directives in place.
This is when the social work spirit really starts to emerge in hospice. Individuals who are not able to formulate their own decisions or express their own wishes still have a right to live and die according to their wishes. Hospice social workers can promote this self-determination by encouraging them to make and record these decisions before a decline in functioning prevents them from doing so.
It’s good discuss the advance directives soon after meeting a new patient. If they are able to communicate their wishes, we can assess how clearly those wishes are understood by the family and friends who will later be expressing their wishes on their behalf.
Definition 1: A document titled Advance Directives (or another name for “living will”)
The term itself can be confusing because it’s used in different ways. Sometimes it is a specific document that specifies end-of-life wishes. It can include a section appointing a medical proxy and describe the type of treatment one wants to receive. It’s great when such a document exists, because it reflects the wishes the patient formulated ahead of time.
Unfortunately, the document may lack a legally binding nature in some states. For example, Five Wishes is a single elegant document that allows people to elect a proxy, describe the kind of treatment they want, their desired level of comfort, how they want people to treat them and what they want loved ones to know. In some states, it is necessary for people using this form to also use a state-specific power of attorney form.
Even when an Advance Directives document exists that elects a proxy and states a wish not to be resuscitated, it is strongly advisable to complete a DNR as well.
Definition 2: A set of end-of-life wishes
The DNR, MPOA paperwork and living will are all types of advance directives. Any statements made by the patient about the care she wants to receive towards the end of her life. Advance directives can mean “everything we know about what the patient wants to have happen as he approaches her death.”
In upcoming articles, I’ll address some ethical issues around advance directives. There are important distinctions surrounding proxies and DNRs that can help you advocate for you patients’ wishes. And there are fine lines to walk when it comes to educating about DNRs.
I have only done hospice in Texas, so some of the details will vary for social workers in other states. But wherever you are, here are some steps to take to start learning about laws relating to advance directives:
- Do internet searches for the following in your state: DNRs, advance directives, medical power of attorney, living will, medical proxy law.
- Ask hospice social workers in your state about how advance directives work in their experience. You can find them by joining the Hospice Social Workers Worldwide and Hospice Social Worker Support Group on Facebook.
- Ask your hospice’s administrator or director questions based on their experience. They may not be as knowledgeable as you want to be about advance directive details. But as supervisors, they have some responsibility to make some judgment calls, and you’ll want to be in sync with them when it comes to these topics.
Next time, I’ll begin with a horror story illustrating how crucial it is for patients to elect the right proxy. See you then!