Every year on April 16, National Healthcare Decisions Day serves as a reminder that medical emergencies rarely arrive with warning. When they occur, the decisions surrounding treatment often must be made within minutes. For healthcare providers, including those in Ochsner emergency departments, the day highlights a simple yet powerful message: Conversations about medical wishes should happen long before a crisis unfolds.
While many people assume advance care planning is only necessary for older adults or those facing serious illnesses, healthcare providers say that belief is a misconception.
“Everybody needs to have their wishes known at least by the time they reach middle age. No one knows what you want to do better than you,” said Foster Kordisch, MD, emergency medicine medical director and president of medical staff at Ochsner Lafayette General Medical Center.
Foster Kordisch, MD
Emergency medicine medical director and president of medical staff at Ochsner Lafayette General Medical Center
“The main thing to remember is that these decisions will be extremely individualized,” Dr. Kordisch continued. “There are definitely some decisions everyone should think about. Do you want to be on a ventilator long-term? Do you want to be an organ donor? Having that information can be so beneficial for everyone if a catastrophe happens.”
Madison Maiocchi, FNP-C, a hospice and palliative care provider at Ochsner Medical Center-Baton Rouge, said advance care planning often begins with reflecting on personal priorities and what quality of life means to each person.
“I ask people, ‘What is most important to you as an illness progresses or a sudden illness occurs? Do you want to maintain your ability to live independently? Would you be comfortable living in a residential care home or having people take care of you?’” Maiocchi said. “Those questions and conversations are a good way to think about what your goals are.”
Madison Maiocchi, FNP-C
Ochsner Medical Center Baton Rouge
Maiocchi said advance care planning in Louisiana centers on three primary documents: a living will, a medical power of attorney and portable medical orders, known as LaPOST.
A living will outlines a person’s general wishes for care, including whether they would want resuscitation or prefer to allow natural death in certain circumstances. It can be notarized or signed by two witnesses who are not related to the individual addressed in the will.
A medical power of attorney designates someone to make healthcare decisions if a patient is unable to communicate their wishes.
“The person you designate as your healthcare power of attorney can change throughout your life,” Maiocchi said. “I encourage people to choose somebody who is really going to listen to their goals. They have to be able to honor what you decide, even if itis not what they would choose for themselves. We’re never really ready to lose a loved one, but one of the most beautiful and selfless things we can do for them is honor their wishes.”
The third document, LaPOST, provides more detailed medical guidance and must be completed with a healthcare provider. It outlines several preferences, including CPR, mechanical ventilation, artificial nutrition and more. LaPOST is documented on a standardized form that travels with the patient, allowing medical teams to quickly understand a patient’s wishes if an emergency occurs. At Ochsner Health, the form is also entered into an electronic registry that allows physicians and advanced practice providers across the system to quickly access a patient’s wishes, with efforts underway to expand similar access statewide.
Maiocchi encourages patients to revisit these documents at least once a year, or whenever their health or life circumstances change.
“People experience life changes, or receive a new diagnosis, or see health improvements. Those situations can prompt them to reevaluate what they want to do. That’s completely fair and something that happens often,” she said.
Emergency physicians at Ochsner hospitals say the absence of these directives can lead to tough conversations when it’s time for decisions to be made. Dr. Kordisch said the protocol is for physicians to focus on providing appropriate, patient-centered, life-sustaining care. They also rely on a patient’s family to help determine what the person may want. To help guide those conversations, physicians often ask relatives to reflect on the patient’s values.
“If there is no documentation, you always try to frame the discussion as what the patient would want,” Dr. Kordisch said. “You have to give them an honest outlook of how you think things will go. It is really hard because nobody wants to be the person who tells the doctor not to try to save someone’s life. It seems to help people emotionally when we approach it from the standpoint of honoring the person’s wishes in the best way they know how.”
J. Michael Cuba, MD, system chair of emergency medicine and chair at Ochsner Medical Center – New Orleans, said that in the absence of advance care documents, physicians must balance their own instincts to provide treatment with the severity of the patient’s injury or illness and feedback they get from family members. Dr. Cuba said that often means emergency physicians at Ochsner hospitals take a “thoughtful pause” when trying to decide the best next steps.
J. Michael Cuba, MD
System chair of emergency medicine Ochsner Medical Center New Orleans
“My job is to do lifesaving procedures, but I realize that’s not always aligned with a patient’s wishes. I have to ask families what the patient has told them, or what they think the person would want to happen next. Unfortunately, the pressure is often on families because those conversations have not taken place,” Dr. Cuba said. “That’s why I really encourage people to talk to their families and have the LaPOST document available when a patient has a life limiting illness whenever possible. It’s not just about you and your own body. It’s also about preparing your loved ones so they don’t have to deal with additional stress.”
Maiocchi emphasized that those conversations can begin with simple questions that establish a broad framework for what kind of care a person would like to receive. It’s often easier to talk about these delicate topics when people are medically stable and not facing an immediate decision. She added that people can change their minds in the moment if an emergency does occur and they have the ability to communicate.
“Just because you decide something on paper does not mean you can’t change those wishes verbally. You can absolutely say you want something different. These documents do not back you into a corner,” she said. “Things happen all the time and happen very quickly. If you desire something different, you can vocalize those new wishes to your healthcare team.”
By openly discussing personal wishes and completing the appropriate documents, people can ensure their healthcare reflects their values while easing the emotional burden on family. National Healthcare Decisions Day is a meaningful reminder that these conversations are one of the most thoughtful and empowering steps people can take for themselves and those who care about them the most.
Ochsner Health is the leading nonprofit healthcare provider in Louisiana, Mississippi and across the Gulf South, delivering expert care at its 47 hospitals and more than 370 health and urgent care centers. To learn more about how Ochsner empowers people to get well and stay well, visit .