Communicating Your Future Health Care Wishes with Advance Directives
If you had a crystal ball and could see into the future, you might know what decisions await you in terms of your medical care. You could tell your doctor in advance of your preferences regarding new treatments and life-sustaining technology.
None of us has a crystal ball but there are ways to plan ahead.
Situations sometimes arise when people are unable to participate in decisions about their medical care; they may be unconscious or have a medical condition that prevents them from communicating. Whom would you want to speak on your behalf in such a case?
Although none of us likes to really consider such a situation, the U.S. Government passed a law which encourages us to do so. It’s called the Patient Self-Determination Act. This act requires hospitals, doctors, and organizations such as the Funds to inform you about making medical decisions in advance.
Today most states have laws which support and recognize giving patients control over their medical care in circumstances where they are unable to communicate their treatment preferences. These laws support the commonly-held belief among patients, families, and medical providers that the best person to make a decision about medical treatments and how long to prolong life is the patient, and the best time to make that decision is in advance, while the patient is still healthy and able to communicate.
If you are ill or injured, but alert, you can tell your doctor what kind of treatment you prefer and whether you consent to what he recommends for treatment. If you want to be able to control decisions about your health care, even when your condition does not allow you to, you need an “advance directive.”
There are basically two kinds of advance directives: living wills and health care powers of attorney.
A living will is a document which contains written instructions that explain your wishes regarding your health care if you have a terminal condition. Most states have laws recognizing living wills and some have forms you can use.
Health care powers of attorney allow you to name a person called a “proxy,” “agent,” or “surrogate,” to make medical decisions for you if you become unable to do so. The health care power of attorney can have more flexibility than a living will because your proxy can discuss your situation with your doctor and participate in all medical decisions even where you are not terminally ill. Most people select a family member or close friend. You may especially want to do this if your state does not currently recognize living wills. Most states do recognize durable powers of attorney to make health care decisions. Some states have special forms for these, too. You can usually combine a health care power of attorney with a statement of your wishes, similar to a living will so that your proxy will have instructions about your preferences.
What Goes into the Advance Directive?
The most important thing to consider is giving the health care proxy the authority to decide whether to forgo or extend life-sustaining, treatment in certain situations. Such extreme situations could be a permanent coma or other unconscious state, irreversible brain damage or disease, or a terminal illness, which have made a patient unable to communicate. These issues can also be discussed in a living will. Some life-prolonging measures which may be considered in an advance directive include:
Intravenous therapy—used to provide food, water, blood products, or medication through a tube inserted in a vein;
Cardiopulmonary resuscitation (CPR)—used to restore stopped breathing and/or heartbeat;
Cardiovascular support—treatment to maintain heart function with medications or mechanical devices;
Respirators—used to help patients breathe when they cannot do so on their own
Feeding tubes—inserted through the nose or through the abdomen into the stomach to provide nutrition, water, and medication when a patient cannot eat normally;
Dialysis machine—used to "clean" patient's blood when the kidneys no longer work properly;
Pain relief—use of medications to lessen discomfort, even if such care may sometimes shorten life.
The advance directive can discuss which kind of treatments the patient would want under what kind of circumstances and whether the preferences are different in situations where there is hope for recovery or whether the treatment would merely prolong dying.
These are all difficult decisions to make. Before deciding, it’s a good idea to talk to your doctor who can explain different types of treatment and technology to you, close family members and friends, and your pastor, who might be able to tell you what your religious faith has to say on these issues. Your values should be your guide.
There is no law requiring you to have an advance directive. Medical facilities, health care providers, and the Funds cannot treat you any differently or discriminate against you whether you have one or not.
How to Create an Advance Directive
1. Each state has somewhat different laws on advance directives. You can obtain a description of the law in your state by requesting it from the Funds Health Call Center. Most hospitals in your state can also provide a description of your state’s law.
2. If your state has developed a special form, obtain a copy of it. Usually they’re designed to be easy to use.
3. After you have spent some time thinking about your wishes and discussing any questions you may have with your doctor, family, and clergy, put your wishes into writing.
4. Sign and date your advance directive. Have it witnessed and notarized, if your state requires. Be sure to choose valid witnesses, such as a friend. In most states, your spouse, close relative, or doctor are not valid witnesses.
5. Give a copy to your doctor and to your health care proxy if you’ve decided to have one, and to a relative or friend who is likely to be notified in an emergency. Keep a copy for yourself.
6. Keep a card in your wallet which states you have an advance directive and where to find a copy, such as the name and telephone number of your physician and your health care proxy.
7. Review your advance directive from time to time, and make any changes as necessary. If you change your mind about having one altogether, you can usually cancel it simply by tearing it up and informing the persons who have copies. If you change any of your instructions in the advance directive, be sure to inform your physician, family, and proxy of the changes.
Where Can I Obtain More Information on Advance Directives?
1. Your local hospital
2. Your state attorney general’s office or state health department
3. Your state bar association
4. American Association of Retired Persons (AARP) at: http://www.aarp.org (search for Powers of Attorney)