An Advance Care Directive specifies your preferences for personal issues relating to your medical care and welfare and can allow you to appoint a substitute decision maker on your behalf.
If your Advance Care Directive ever needs to be used, it will only be when you are unable to either make or communicate your decisions.
If you have lost the capacity to make or communicate decisions, your nominated substitute decision maker and those involved in your care will need to refer to the directive to know what you would have wanted for your health care treatment and to act accordingly.
Lately when preparing Advance Care Directives for clients I have been asked to explain the different levels of care that can be included in the binding legal directives section of the document.
There are four types of care for someone with a life threatening illness:
- Intensive level of care
- Active level of care
- Limited level of care
- Palliative level of care
‘Intensive level of care’ uses every available piece of technology to maintain life. Technology in this instance includes antibiotics, tests, life support, transplants, and blood transfusions and so on. In serious medical emergencies, patients usually go straight to the Intensive Care Unit. ‘Intensive level of care’ is the obvious level of care when the person has a good chance of recovering fully or at least to their acceptable level of functioning.
The aim of ‘active level of care’ is to prolong life, but not to maintain it indefinitely through life support technology. ‘Active level of care’ includes elective surgery, investigations (such as blood tests, x-rays), antibiotics and transfusions. It does not extend to putting someone on a ventilator, unless they are having surgery or recovering from surgery.
‘Limited level of care’ includes fewer options than active care. It is limited because only limited measures are taken to prolong life. While the patient may have oral or intravenous antibiotics, x-rays, oxygen, transfusions and blood tests or intravenous (IV) fluids for rehydration, elective surgery is not part of this level of care. It only includes surgery when the purpose of the surgery is to improve comfort; for example to relieve the pain of a fractured hip. The patient would not be put on a life support machine (ventilator). If their kidneys were failing they would not go on a kidney machine.
People who have an irreversible, life threatening illness and live at home might choose ‘limited level of care’. It means that they would only go to hospital if they couldn’t receive the necessary medical care at home.
The aim of ‘palliative level of care’ is to provide physical, social, psychological and spiritual support, and to keep people comfortable and pain free. Prolonging life is not the aim of this treatment. ‘Palliative level of care’ may include surgery, tests and medications, but only when the purpose of such treatments is to improve comfort.
This is the level of care generally offered to people who are dying. It is possible to arrange palliative care at home, but only if the person’s needs can be met at home. Otherwise it can be offered in a hospice, palliative care unit or other facilities, such as a hostel or nursing home.
If you wish to record details of your treatment in your Advance Care Directive it is important that you understand the above definitions and that you think carefully about your current and future health and what is most important to you.
The information regarding 'levels of care' has been sourced from Advance Care Directive Association Inc (ACDA).