With the success of modern medicine, the average lifespan has increased to the late 70s, and increasing numbers of people are living into their 80s and 90s. The bad news of this is that more of us are spending those final years dealing with a heavy load of illness and frailty before we die.

One way to lessen the burden is to be prepared. That is where advance care planning comes in. We need to begin talking to each other while we are healthy about what is important to us, what makes our life worth living and at what point suffering and burden would be too great to go on.

These important conversations and communications with our friends and family can be documented with an advance directive.

What is an advance directive?

  • An advance directive usually takes the form of a living will and/or durable power of attorney for health care.
  • An advance directive is for anyone age 18 or older and provides instructions for future life-sustaining treatment.
  • An advance directive appoints a health care representative and can guide inpatient treatment decisions. (It does not guide emergency medical personnel.)

Conversations and communications about advance care planning need to be revisited from time to time, because your wishes and needs may change.

This becomes even more important over time as about 70% of us will lose at least some ability to participate in decisions about our care as we approach the end of life.

DMOST – another way to make your wishes known

Delaware Medical Orders for Scope of Treatment (DMOST) is a complementary way to document your intentions for your health treatment.

DMOST reflects the shared decision-making process between patient or surrogate and health care provider regarding medical treatment options. The form allows documentation of preferences that can be incorporated into your health care record. Similar forms have been shown to align medical care near the end of life to a person’s preferences.

  • DMOST or the national POLST (portable medical order) can be for anyone with a serious illness near the end of their life, at any age. The DMOST statute was passed in 2016 and is the Delaware version of the national POLST form.
  • DMOST provides medical orders for current treatment, can guide actions by emergency medical personnel and can guide inpatient treatment decisions.
  • It is important to note that DMOST is not a replacement for the advance directive.
  • More information about DMOST is available from your health care provider or at the Delaware Quality of Life Coalition.

All of these tools help our loved ones, or those we designate to speak for us, do a better job as our surrogate decision-maker because they have a clearer picture of what decisions or choices we might make in a given situation. These care choices are often complicated, confusing and emotionally difficult for those who are thrust into the role of surrogate decision-maker.

“I have an advance directive not because I have a serious illness but because I have a family.”

— Ira Byock, M.D., palliative care physician and advocate

While advance care planning tools are not perfect, there is good evidence, especially with DMOST, that they can increase the likelihood that the medical care we receive near the end of our life is consistent with our preferences.

Steps you can take now

  • Engage those closest to you in a conversation about health care decision-making.
  • Complete an advance directive form.
  • Complete a durable power of attorney form for health care.
  • Complete a DMOST form if appropriate for the circumstances.
  • Talk with your health care provider if you have questions.

Talking about health care decision-making is one of the most important conversations you’ll ever have.