Skip to Content

Advance Care Planning

Advance directives
By Susan Morgan, ACP-GV Coordinator

"Death is not the opposite of life, but a part of it." --Haruki Murakami

As a society, we don’t like to think about death, and we certainly don't want to talk about it. The belief that one can influence events by thinking or talking about them is a concept known as Magical Thinking. In her article "Ta-Da! Magical Thinking Explained," author Crystal Raypole describes magical thinking as "A belief that you can influence real-world events with certain actions or rituals." For example, if we talk about and prepare for an end-of-life event, we influence an action or an event that may bring death upon us, therefore, it's better left unsaid

However, there are many advantages to Advance Care Planning. When you dispel Magical Thinking, it is not much different than planning a trip. For example, one would ask themselves who is a trusted traveling companion? What will bring the most joy - making the trip worthwhile? Mode of transportation?  How long to stay? What clothes are needed? Reservations, financing, lodging, etc. We ask ourselves these questions in advance so that our trip is successful and enjoyable. 

Advance Care Planning presents the same opportunity: Planning in advance and while you have decisional capacity to ensure your medical team and your loved ones understand what is important to you, so that your medical wishes are honored.  Other benefits include: 

  • Advance Care Planning helps ensure you receive medical care that is consistent with your beliefs, values, and preferences. You maintain control of your medical care when you are not able to verbalize what treatments you may or may not want.
  • Advance Care Planning avoids family members and loved ones having to guess what medical treatments you would want.
  • Advance Care Planning helps lessen the stress, anxiety and depression of family members and loved ones. 
  • Advance Care Planning can lessen conflict between family members when there is a designated person(s) who have been identified to make medical decisions. 
  • Advance Care Planning ensures that a trusted person(s) will make decisions on your behalf rather than someone that may not have your best interest at heart.
  • Advance Care Planning can improve end-of-life care to your satisfaction, as well as your family members and loved ones.

Advance Care Planning is a Four Step Process

  1. THINK about what matters most now.  What brings meaning and purpose to life?  What is most important - quality of life or quantity of days? What defines quality of life? 
  2. TALK to family, friends, medical team, care givers and others about what is important to you, what you value, what you fear and hope for. 
  3. SHARE medical goals and preferences with your family, friends, loved ones and medical team.
  4. WRITE out your medical wishes. Complete an Advance Directive. Designate a Health Care Agent and record your medical goals of care and treatment wishes.

The last step in the Advance Care Planning process is to complete an Advance Directive.  There are various types of Advance Directives: 

  • Health Care Power of Attorney:  A legal document used to name someone to make medical decisions for an individual if they are not able to make medical decisions for themselves. The person designated is often referred to as a Healthcare Agent or Medical Power of Attorney. The authority over this document is the individual completing the document.  A Health Care Power of Attorney can be completed by an individual with no medical or legal assistance involved.
  • Living Will:  A legal document that expresses an individual's desired medical wishes, mostly about prolonging life with life sustaining treatments if death were imminent. The authority over this document is the individual completing the document. It can be completed by an individual with no medical or legal assistance, however, it is highly recommended to speak with your medical provider regarding 'goals of care'.
  • Physician Orders of Life Sustaining Treatment: Complements an Advance Directive by translating medical wishes into actionable medical orders. The authority over this document is a medical provider. It must be completed with a medical provider, as it is a medical order for medical personal to adhere to.
  • South Dakota Comfort One: Do Not Resuscitate (DNR). This is an actionable medical order that informs medical personal to not administer cardiopulmonary resuscitation (CPR) if an individual has no pulse and has stopped breathing. The authority over this document is a medical provider. It must be completed with a medical provider, as it is a medical order for medical personal to adhere to.  

Keep in mind that your wishes are a snapshot of your current medical preferences - over time your preferences may change.  Advance Directives should be reviewed yearly and can be updated at any time, to reflect any changes in your desired medical wishes and/or medical condition.

The Sioux Falls VA Health Care System offers Veterans and their loved one's assistance with education and completing Advance Directives through individual visits with a social worker or other medical provider or visits in a group setting, known as Advance Care Planning-Group Visits (ACP-GV).  ACP-GV allows Veterans and their loved ones to engage with others in a group discussion to think about their health care goals. 

Anyone of adult age can and should complete an Advance Directive - whether you are healthy and are free of any chronic medical conditions or have been given a limited life prognosis. Completing an Advance Directive is the best gift you can give yourself and your loved ones - and it's free!

“Death is part of life like happiness, pain, and joy…it deserves the same honor and respect as everything else.”     

                                                                                                     - Carrie Fisher-Pascual

For more information on completing an Advance Directive contact Susan Morgan, ACP-GV coordinator at 605-336-3230 ext. 5911 or susan.morgan1@va.gov.