Being in pain at the end of life can be more terrifying than death itself. Modern health care focuses attention on this concern through pain management and palliative care. In California, all hospitals and nursing homes are required to assess a patient's pain condition as a fifth vital sign - along with the patient's pulse, temperature, respiration and blood pressure. Palliative care is given to patients who face serious illness for which there is not a cure. Palliative care seeks to make the patient's life as comfortable as possible by controlling pain and symptoms, by easing the patient's concerns over daily living needs, and by helping the patient and family address psychological and spiritual needs. Respect for the patient's culture, beliefs and values are essential components of palliative care.
The form of the Advance Health Care Directive is not universal and each state and country developed its own form, so when working with patients from out of state or out of the country, its important to check the legal requirements and compare to our own state form. Some people prefer to use another form called Five Wishes. This is a simplified form that focuses on what you want family and loved ones to know rather than recommendations for the medical staff. This form is available online and can be used in any state but it is not legally binding. The Uniform Law Commission adopted a Uniform Health-Care Decisions Act in 1993, but only seven states have adopted the act (Alaska, Delaware, Hawaii, Maine, Mississippi, New Mexico, and Wyoming), and even then, only with their own variations. Most states have adopted language to indicate they will recognize the validity of out-of-state directives if: (1) they are valid in the state where executed or (2) if they meet the requirements of the state where treatment is delivered. Some states add a presumption of validity unless the provider has knowledge to the contrary.
The California Coalition for Compassionate Care is a statewide collaborative of more than 50 organizations representing healthcare providers, consumers and state agencies committed to improving end-of-life care for Californians. The Prepare for Your Care website has Advance Directives in most of the languages spoken by patients in California printed in English and the other language so that doctors, nurses, social workers and chaplains can help patients to fill out these forms.
Our palliative program has been working with the inpatient oncology unit and outpatient infusion clinic to educate the public about the advantages of having an Advance Directive. My counterpart Rev. John Onuoha and I obtained Notary Public licenses to facilitate authenticating Advance Directives for patients who complete them in the hospital. We helping to promote Advance Directive awareness and educate staff and visitors on April 16, National Health Care Decisions Day.
