ADVANCE DIRECTIVES

INTRODUCTION

Advance directives center around the principles of your right to die and death with dignity. With an advance directive, you can express how much or how little you want done for you when you are no longer able to make these decisions.

DEFINITION

Advance directives: An advance directive is a written document or series of forms. It needs to be signed to make it binding. The document indicates an individual's choices about medical treatment. In the document, you can also name someone to make decisions about your medical treatment on your behalf if you are no longer able to make these decisions yourself. This designated person becomes the durable power of attorney for health care. By completing the appropriate advance directives, you can predetermine any medical decisions, including endof-life decisions, about your future medical care in a legally sound way.

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Two types of advance directives are generally completed: 1. A living will 2. Medical power of attorney (also referred to as designation of a health care surrogate or health care proxy).

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Advance directives are a way of making your voice heard when you can no longer communicate. Advance directives are not just for the elderly. All 50 states and the District of Columbia have laws regarding advance directives. Authorities also agree that no difference exists between withholding lifesaving treatment and withdrawing life-support treatment.

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An advance directive does not mean "do not treat." This is a common misperception and not correct. Of course, if you want it to mean do not treat, then that is something that your surrogate needs to know. Proper execution of an advance directive is a delicate task. A person should discuss this with his/her loved ones and consider his/her inner values and beliefs.

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1.

Living will: This written statement tells health care professionals what type of life-prolonging treatments or procedures to perform if someone has a terminal condition or is in a persistent vegetative state.

SAMPLES OF LIVING WILL/ADVANCE DIRECTIVE/DURABLE POWER OF ATTORNEY

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2.

Medical power of attorney (or designation of a health care surrogate): This legal document allows you to select any person to make medical decisions for you if you should become temporarily or even permanently unable to make those decisions for yourself. This person is also referred to as your attorney-in-fact or durable power of attorney for health care, but it is not necessary for them to be a lawyer.

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Common situations in which a person may be temporarily or permanently unable or incapable of making complex judgment or end of life decisions are:
a. b.

c.

d.

coma (from any cause); stroke (if it results in coma or cognitive deterioration); moderate or severe dementia (Alzheimer's or other types); persistent vegetative state;

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e.

f.

g.

severe illness requiring placement on breathing machine and inability to communicate; severe medical conditions such as advanced liver failure or kidney failure; traumatic brain injury resulting in the inability to make complex decisions.

REASONS FOR AN ADVANCE DIRECTIVE

1. 2.

3.

You want to be sure your voice is heard when you can no longer communicate. You want to be sure that your wishes are respected and followed in the event that you are unable to make medical decisions for yourself. You want to be sure that you are not placed on life-support machines or receive other life-prolonging treatment against your wishes if you suffer from a terminal condition.

REASONS FOR AN ADVANCE DIRECTIVE

4.

You want to be sure that, if you fall victim to a cardiac arrest after you have suffered with a long-term, end-stage medical condition, cardiopulmonary resuscitation (CPR) or other heroic measures will not be performed so long as this is in line with your values and preferences.

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If you cannot speak for yourself and you do not have an advance directive, then health care professionals will look to the following people, in the order listed, for guidance with your care:
a. b.

c.

d.

Your guardian (if court appointed) Your spouse Your adult child (or the majority of adult children who are reasonably available) Either of your parents

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e.

f. g.

h.
i.

Your adult brother or sister (or the majority who are reasonably available) Other adult relatives A close friend who is familiar with your activities, health, or religious or moral beliefs Caregivers A court-appointed or state-assigned conservator in cases where no relative or friend exists to guide medical decision making (conservators may be previously assigned to a patient, otherwise this could be a very lengthy legal process)

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j.

Primary care physicians or attending physicians are in rare cases asked to comment or decide on a patient's behalf and in patient's best interest if all efforts have been exhausted to find a surrogate decision maker.

A HEALTH CARE SURROGATE

You can select just about any adult to be your attorney-in-fact (surrogate). Select someone who is aware of your wishes and values and whom you trust will be able to make the decisions (regardless of how difficult) at a time when needed.

A HEALTH CARE SURROGATE

You can select a spouse, adult child or sibling, or even a close friend. You should not select your doctor, your doctor's employees, or any staff of a facility where you live (such as a nursing home, hospice, or assisted living facility) because of a possible conflict of interest regarding the type of care you would or would not receive.

A HEALTH CARE SURROGATE

The surrogate can only make decisions for you when you are temporarily or permanently unable to make your own health care decisions. An attorney-in-fact (surrogate) can make just about any treatment or procedure decision that is consistent with accepted medical practice and consistent with your wishes.

A HEALTH CARE SURROGATE

You should only appoint one person to be your surrogate, but others may be selected to serve as alternates in the event the person you have chosen is unavailable or unable to make decisions. Surrogates cannot be held liable for decisions made regarding your care or for costs associated with medical care.