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Don't Wait to Make Important Health Care Decisions

Jonathan Nasseri, MD, FACP News

In the busyness of our day-to-day lives, it’s often difficult to complete all the tasks that have to be done right now. Forget about planning

ahead months or years into the future. However, there are some things that are so vitally important that they’re worth setting aside some time

now so you’ll be ready for critical decisions you or your loved ones may have to face at some point in your life.

One of those future issues you should consider now is the type and degree of health care you want to receive if you ever become incapacitated

and can’t make choices for yourself. This is not an easy or pleasant topic to think about. Nevertheless, making plans now can take a tremendous

burden off of your loved ones and help you receive not only the best possible care, but the care that you specifically want.

April 16 is National Healthcare Decisions Day. If you haven’t taken time yet to make health care choices for yourself, this is a great

opportunity to do so.

As a hospitalist and a palliative care physician at Simi Valley Hospital, I work exclusively within the hospital to help provide and coordinate

the care of admitted patients. Nearly every day, I witness the value of taking the time to make certain health care decisions before they become

a necessity.

There are a few different ways you can make your health care choices known. Probably the best known method is an advance directive. There are

two types of advance directives: the health care power of attorney and the living will. The health care power of attorney enables you to

designate a family member, friend or other person you authorize to make decisions about your health care if you can’t do so for yourself.

The second type of advance directive is the living will, which spells out what type of medical treatments you do or do not want to undergo in

order to keep you alive. You can see a list of various sources for advance directives on the National Healthcare Decisions Day website. Go to and click on “get your advance directive.”

Those of us who live in California have another excellent option for expressing our health care wishes called the Physician Order for Life-

Sustaining Treatment, or POLST. This form is easy to fill out, concise and more specific than a typical advance directive. There are just three

main sections—resuscitation, extent of treatment and artificial nutrition—and choices within each section that very clearly spell out your

wishes and the degree to which you want them carried out. To learn more about this form, go to

Though they are not found specifically in advance directive or POLST forms, two other issues that are important for you to consider and to talk

with family members about are your wishes concerning palliative care and hospice care. Both approaches focus on improving the quality of life

for patients, but there are also important differences between the two.

By definition, hospice care is appropriate for someone whose terminal illness, if it runs its natural course, is expected to result in death in

six months or less. Palliative care, on the other hand, applies not only when there is a terminal illness but also for patients who are not

terminal but have a serious, chronic condition, such as cancer, advanced congestive heart failure, advanced COPD or emphysema, or advanced liver

or kidney disease.

In either case, a team of professionals—typically including a physician, nurse, spiritual or religious figure and a social worker—discusses the

patient’s and family members’ wishes for care with them then helps to carry out those wishes.

In whatever way you approach making your health care wishes known, it’s important to take the time to do so before circumstances make such

decisions necessary. Remember to make your wishes as specific as possible, put them in writing and sign the form. If you have questions about

end-of-life care, advance directives or POLST forms, your doctor can help you understand the various options and how they affect the care you


Jonathan Nasseri, MD, is a hospitalist and palliative care physician at Simi Valley Hospital.