What are advance directives?
If competent adults want to maintain control over the health care
treatment decisions that may be needed if they become incapacitated,
several legal options are available. Documents known as "advance
directives" can be prepared in advance of any incapacitating illness
or condition they might suffer.
One type of advance directive is a "living
will," also referred to as a "medical directive" or
"declaration." A living will is simply a written instruction
spelling out any treatments that an individual wants, or does not want, in
the event that he or she is incapacitated and permanently unconscious or
terminally ill.
A health care power of attorney (HCPA) is another
important document that allows an individual to legally appoint someone to
serve as his/her authorized "agent," (or
"attorney-in-fact" or "proxy" or "surrogate
decision maker"). This document also may be referred to as a
"health care proxy," "health care surrogate," or
"power of attorneys for health care." A HCPA applies to any
medical condition specified and allows the designated agent to apply some
interpretation or implementation to situations that may occur.
Must a patient have an advance directive?
No. The Patient Self-Determination Act (PSDA) is an information and
Education statute only. Health care providers must not discriminate on
whether or not you have an advanced directive.
Why bother?
Medical technology has progressed so dramatically that life can now be
prolonged. Sometimes this medical ability creates ethical and moral
dilemmas. Families, friends, and physicians can be torn, trying to
determine what an incapacitated patient would have wanted in such a
situation.
Can an advance directive be changed?
Advance directives can be changed at any time; however, it is important to
notify your family members, the person you have selected as your surrogate
decision maker, as well as your physician if this is done.
Is it necessary to see an attorney to prepare
advance directives?
No. Many hospitals, physicians, and organizations now have forms that can
be used to execute advance directives. However, an attorney who is
knowledgeable regarding health care planning may be able to help you
ensure that your documents adequately protect your interests and desires.
When Are Advance Directives Needed?
You are in a nursing home with Alzheimer's disease which causes you to
be confused and disoriented. You fall, fracture your hip, and now you
require a hip replacement. Since you are unable to make the decision, who
will consent to the treatment?
You are struck by a speeding motorcycle while crossing
the street. While you are unconscious at the hospital, your doctor
determines that you need a blood transfusion. For religious reasons, you
have objected to transfusions in the past. Now that you cannot voice your
objection, how can you be sure that your wishes will be protected?
After being treated for a heart condition, you suffer a
stroke. As a result, you have severe brain damage, are now in a permanent
coma, and are not expected to live more than a few months. You are fed
through a tube. Should the feeding tube be removed? Who will make the
decision? How should the decision be made?
In most health care situations, you have the right to
make decisions about your medical treatment. Based on information you
receive, as well as your values and beliefs, you must weigh the risks and
benefits of the proposed treatment. Ultimately, you decide which
treatments you want and which ones to refuse. However, there may be a time
when your illness, injury, or disability prevents you from being able to
make your own decisions. Even if you are unable to make the decision, a
decision will still be made. The issue becomes how much control you wish
to exert over those decisions.
Recent advances in technology have increased the ability
of the medical profession to extend life where formerly an individual
might have died. Many people are increasingly concerned about the quality
of the life that they will experience as the result of these advances in
medical technology. This is particularly the case where an individual is
mentally or physically incapacitated and unable to make decisions about
medical care.
Courts have almost always followed expressed wishes of
competent adults. A competent adult can communicate preferences about
future medical treatment through legal documents called advance
directives. By using advance directives, you can control your health care
decisions, even if you become incapacitated in the future. You prepare the
advance directives while you are capable of making your own decisions.
Generally, they take the form of instructions to your doctor, or
appoint someone to make decisions for you. They can cover specific
treatments such as life-sustaining procedures, or be very general and
cover any medical decisions.
An advance directive can allow you to participate in
such decisions as:
- Choosing health care providers ( doctors, nurses,
home health aides, etc.);
- Deciding who can have access to your medical records;
- Choosing the type of medical treatment you will
receive;
- Consenting to or refusing certain types of medical
treatment; and
- Choosing the person who will make decisions for you
when you are unable to do so.
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