Advance Directives for Medical Care

 
You can decide in advance what medical treatment you want to receive if you become physically or mentally unable to communicate your wishes. As an adult in a hospital, skilled nursing facility, or other health care setting, you have the right to (a) keep your personal and medical records private, (b) know what kind of medical treatment you will receive and (c) tell people ahead of time what type of treatment you want, or don't want, in case you lose the ability to speak for yourself. You can do this by preparing an Advance Directive.

What is an Advance Directive?

Generally, an Advance Directive is a written document that tells people how to make your medical decisions when you can't make them for yourself. An Advance Directive can also designate someone else to make medical decisions for you. Two common Advance Directives are a Living Will and a Durable Power of Attorney For Health Care.

A Durable Power of Attorney for Health Care is a signed, dated, and witnessed paper that authorizes someone else to make your medical decisions if you are unable to make them for yourself. This can include instructions about any treatment you want to avoid. It is also commonly called a Health Care Proxy.When choosing your agent, make sure he or she knows your wishes, values and preferences. If you use a form document, do not just sign it -- read it carefully and tailor it so that it clearly expresses your values and wishes. An important question to ask yourself is: "Do you want food and fluids withheld under any circumstances?"

A Living Will is a written document that generally states the kind of medical care you want (or do not want) in case you become unable to make your own decisions. It's called a Living Will because it takes effect while you are still living. While most States have their own Living Will forms, you might also be able to write a personal statement of your preferences for treatment. A Living Will differs from a Durable Power of Attorney for Health Care in that a Living Will does not appoint an agent and, in many States, applies only to terminal illness or persistent vegetative state.

Because the Living Will applies only in narrowly and sometimes unclearly defined circumstances, it is best to have both a Living Will and a Durable Power of Attorney for Health Care or to combine them both in one advance Directive. Your Advance Directives should be part of your medical record.

Which is Better: A Living Will or a Durable Power of Attorney for Health Care?

In some states, laws may make it better to have one, the other, or both. The decision is up to you. But remember, a Living Will doesn't allow you to name someone to make your medical decisions, if that is what you want. Check with your attorney or you may want to consult the State Attorney General offices.

Federal law requires hospitals, skilled nursing facilities, hospices, home health agencies and managed care plans to give their patients who are covered by Medicare or Medicaid information about Advance Directives. The law is intended to increase your control over medical treatment decisions. However, health care providers only have to provide information about the laws for the State in which they are located. Laws governing Advance Directives differ from State to State. Also, the laws on honoring Advance Directives from one State to another aren't clear. If you live in one State, but travel to other States frequently, you may want to consider having your Advance Directive meet the laws of other States. A good source of information is the Office of the State Attorney General.

Points to Consider

1. You don't have to have and Advance Directive if you don't want one.

2. If you have an Advance Directive:

  • Tell your family. Make sure they know where it is located;
  • Tell your lawyer.
  • Tell you Doctor. Make sure the Advance Directive is part of your medical records.
  • If you have a Durable Power of Attorney, give a copy of the original to that person.
  • Keep a small card in your purse or wallet that notifies Emergency Medical Services (EMS) providers of your wishes. (EMS generally refers to ambulance companies and paramedics). However, in an emergency situation, EMS staff don't have much time to look for, or to evaluate different types of documentation. They may only acknowledge cards issued by the State's EMS Program, and only when the cards are signed by your personal physician.

Canceling an Advance Directive

You may change or cancel your Advance Directive at any time. Any change or cancellation should be written, signed, and dated. Give copies to your doctor and to anyone else to whom you may have given copies of the original. Some States allow you to change an Advance Directive by oral statement. To check the laws that apply to your State, contact your State Attorney General.

If you want to cancel an Advance Directive while you are in the hospital, notify your doctor, your family, and others who may need to know. Even without a change in writing, telling your doctor directly about your wishes generally will carry more weight than a Living Will or Durable Power of Attorney as long as you can decide and communicate for yourself.

For Additional Information

Preparing an Advance Directive lets your physician and other health care providers know the kind of medical care you want, or don't want, if you become incapacitated. It also relieves your family and friends of the responsibility of making decisions regarding life-prolonging actions.

If you need help in preparing an Advance Directive, or if you would like more information about them, you may want to contact a lawyer. You may also consult your State Attorney General's Office, the State Office on Aging, or an Insurance Counseling Program for Medicare beneficiaries. Each State has its own laws and regulations regarding Advance Directives.

Source: Health Care Financing Administration

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