Advance care planning: How values influence care

Mary was an 84-year-old widow, grandmother and retired teacher who was in generally good health — until she was diagnosed with a lifethreatening blood cancer. She declined a referral to get specialty care, saying she was content to follow a deeply felt belief to “not attempt to thwart Divine will.” Instead, her family and care team followed her wishes for comfort care. She died four weeks later with her family near.

Lucretia was a physically fit 80-year-old woman who had severe cognitive impairment. Then, a common cold rapidly escalated into severe respiratory distress. Lucretia required respiration support with a ventilator. She didn’t have a living will or other advance care documents to indicate the type of care she would want with life-threatening illness. Since she didn’t have the capacity to decide for herself, her spouse was asked to decide. He deferred to their children who were equally divided. Half felt it best to use the medical tools available. The others believed that their mother would not want aggressive lifesupporting tools and preferred comfort measures even if it would end in her death. Assisted by a palliative medicine consultative team to better understand their choices, the family decided to treat Lucretia. She lived a few more months.

Mary’s intentions were well planned and able to be shared, which meant she could focus on living well even when facing death. Lucretia did not have a plan in place, nor did she have a voice, which meant her family had to choose for her when her health took a turn. Inevitably, important choices need to be made with a life-changing or life-threatening diagnosis. A palliative medicine team can guide people through the treatment options.