This article covers the basics of advance directives and the different types of legal documents that you might need to protect your medical desires and wishes. Many people are unaware of the legalities of making these decisions and are ill-prepared when they are most necessary.
An advance health care directive is a sort of legal document that explains to your doctor and family about your wishes of your health care. There are different types of these directives that apply to different situations. These directives are put in place so that if a time ever arises that you cannot speak for yourself, you will have your own words and wants on this paper to ensure that your medical care team knows your wishes.
Informed consent is another aspect of the advance directives. This sort of consent is what is given to your doctor or specialist when they perform a new treatment or procedure on you. You are given an information sheet with details about your procedure and asked to sign off on it, approving what has been agreed upon. This is informed consent. Most adults can give consent for themselves. Adult parents sign for their children, and in some cases, a power of attorney could sign for their relative or friend they are caring for.
In some situations, like that of an unplanned emergency room visit, a doctor may need to act in accordance with their patient’s immediate need and take action without consent. In these life-chasing situations, no consent is allowed.
Any competent adult is also allowed to deny consent for any medical testing or treatment as long as they understand all the outcomes of refusing. This can be called informed refusal. An adult can also ask that treatments be stopped, even if that means that they will face their death.
Whether you have or do not have an advance directive your medical care will not be affected. Many states in the USA have passed laws that state that family members may act on behalf of a person who cannot speak for themselves. This is an excellent option for families who are close and get along well. For families who disagree and find themselves butting heads, this option might not be as beneficial as others and in turn, delay the decision making which could be detrimental.
In certain types of advance directives, you are allowed to choose a proxy, or substitute person, agent or surrogate, to make these decisions and choices for you when you cannot make them for yourself. These advance directive documents only apply to your heal care decisions and no other part of your life. These will not affect your financial or estate matters. Those are different types of legal documents needed.
What are the different types of advance directives?
Within your written advance directives there can be a multitude of information, decisions, and choices tied to the specific type of advance directive you have. Some of those are listed below.
- Organ and tissue donation instructions can be placed in your directives. Most states have their own systems to identify organ donors either by adding it to the driver’s license or state identification card or issuing a wallet card.
- The Living Will is a document made to help control certain future health care decisions only when a person becomes incapacitated to make the decisions themselves. The person must also have a terminal illness or permanent unconsciousness or vegetative state. Laws on this vary by state, so be sure to verify your own localities regulations. If a person has any hope of survival or living, the living will generally does not apply.
The living will cover the type of medical treatment you as a person would want or would not want in certain situations. It can cover when you would like life-saving measures and where you would limit certain measures being taken. This could apply to life-saving measures such as tube feedings, artificial life support like breathing machines, or dialysis.
This legal form must be filled out and signed by the patient and a witness in most all states. Some states require a notary be present to make the document more official. In most situations, witnesses are needed to sign and cannot be spouses, potential heirs or doctors caring for the patient.
There are many things to consider when creating your own living will. Some of them are:
- The use of equipment such as dialysis machines for kidneys, ventilators or breathing machines.
- “Do not resuscitate” orders (instructions not to use CPR if breathing or heartbeat stops)
- Whether you would want fluid by IV or nutrition via tube feeding to the stomach if you couldn’t eat or drink
- Whether you would want food and fluids even if you weren’t able to make other decisions
- Whether you want treatment for pain, nausea, or other symptoms, even if you are not able to make other decisions. In many cases, this is referred to as comfort care or palliative care.
- Whether you want to donate your organs or other body tissues after death
At any time, you can make changes to or revoke your advance directives, or any specific clause therein. In some states, you must re-file your living will as they will expire after a few years span. If you live in more than one state, you should have a living will done in each state. This is especially important for DNRs. Be sure to have a copy of your advance directive at every doctor’s office or hospital you frequent so they can have this one file.
- A durable power of attorney or health care power of attorney is a legal document done where you name a person to be your proxy to make all of your health care decisions if and when you become unable to do so. Many state laws vary on the levels of freedom your agent has to make certain decisions. If you are unsure of what your state’s proxy laws are, simply contact your lawyer to ask these questions. Be sure to verbalize all that is in the advance directive to your proxy and choose a backup agent in case your first proxy becomes unavailable. States have special forms for the declaration of a proxy. Be sure to get the correct documents for your state requirements.
- Do Not Resuscitate orders are legal documents that state your wants when it comes to sustaining your life via resuscitation. Resuscitation is an attempt by a medical professional or person to re-start your heart and breathing, like CPR. In other cases, breathing machines could be considered a life-saving measure. These orders mean different things depending on where you are. You should always be sure to have a copy on file at any location you are seeking treatment or could be treated. Some carry wallet cards with their DNR information to be sure.
In a hospital, a DNR order means that if you stop breathing or your heart stops beating, nothing will be done to keep you alive. This order allows the person to have a natural death and, in some states, referred to as an “allow natural death order.” In the hospital, you can ask your doctor to add a DNR to your file at any time. Some hospitals require a new order every time you are admitted, but these types of orders are only good in the hospital when you are there.
Outside of the hospital, a DNR order is mainly for EMS and ambulance drivers who answer 911 calls and are usually required to attempt resuscitation and prolong life in every way they can. Another type of this form is called the Do Not Attempt Resuscitation or DNAR form. This form allows people to deny resuscitation attempts in advance, even if the EMS is called. This form must be signed by the patient and the doctor.
- Physician Orders for Life-Sustaining Treatment or POLST is not exactly an advance directive, but a set of specific medical orders that a seriously ill person can fill out and ask their doctor to sign. This form is kept with you and can be used in different medical care settings. Emergency workers must follow these orders. Without a POLST form, emergency staff are usually required to provide every possible treatment to keep you alive. You can find your state’s specific POLST form requirements by visiting www.polst.org.
- Pregnancy is another life situation that many people do not think to have advance directives for. Of course, the goal in pregnancy and delivery is a healthy mother and baby, and those steps are almost always taken immediately. However, if you could become pregnant, you should consider the following things:
- the risks that could occur to both you and the fetus
- how far along you are in the pregnancy
- the policies of the doctors and medical facilities involved
What is the Patient Self-Determination Act?
The Patient Self-Determination Act or PSDA is a law that encourages all humans to decide early in life about the extent and types of medical care they want to accept or deny if they become unable to make decisions due to illness. The PSDA states that all health care agencies recognize the living will and durable power of attorney for health care. This act applies to hospitals, long-term care facilities, and home health agencies that get Medicaid or Medicare reimbursements.
This information is often given in writing, as it is a requirement of the law. You are entitled to receive information about creating your own living will, DNR and other forms and medical wishes at the time of visit with a new doctor.
What are common questions asked about advance directives?
There are many questions asked about advanced directives that can be answered by medical professionals or lawyers that deal with medical law. These are some of the more commonly asked questions:
What is considered life-sustaining treatment?
Generally, life-sustaining medical treatment is anything mechanical or artificial that sustains, restores or substitutes for vital body function or could prolong the dying process in a terminally ill human. Life-sustaining medical care includes:
- Cardiopulmonary resuscitation or CPR
- Artificial respiration which includes: mouth-to-mouth breathing, manual ventilation, or a ventilator or respirator – a “breathing machine” that pushes air into the lungs with force.
- Medicines to help with blood pressure and heart function
- Artificial nutrition or hydration like liquid food or fluids given through a tube to the stomach or into a vein
- Dialysis which is a process that does the job the kidneys normally do.
- Certain surgical procedures such as amputation, feeding tube placement, tumor removal, or organ transplant
When should I make my advance directive?
Actually, do you have a moment now? Most doctors and specialists agree that the sooner you have decided what types of medical care you want and do not want, the better. People of all ages should consider their personal medical wants and needs and see to it to take action before it is too late. Many people wait until they are in the hospital under duress or miss the opportunity altogether. These documents can be updated or changed at any time once completed. It is very important that your proxy or family know of your desires for medical care in certain situations. While it is not possible to plan for every instance of medical chaos in your life, you can do your best to think ahead to the major situations that many people face. Due to the fragileness of life, some people choose to have a medical power of attorney and a living will that covers all of their wishes.