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Advance Medical Directives Ensure Respectable Treatment

“Advance Medical Directives” is the term describing the multiple legal documents that should be completed and submitted to your guardians and healthcare professionals to insure that you are given the treatment and care that you desire.  There are three main documents you need to have. Laws regarding these documents do differ from state to state—you can have these drawn up by a qualified attorney, or you can contact your state’s attorney general office. You may also find forms online: Caring Connections has links to Advance Directive forms from every state.

Here’s what the forms consist of:

Healthcare Power of Attorney (HPOA)

Each state has its own rules about who a court will designate to make decisions for you if you are unable to communicate your own wishes. Don’t leave this decision to a judge; make it for yourself by appointing a Healthcare Power of Attorney.

An HPOA document usually states that if an attending physician and one other physician or licensed psychologist deem a person unable to communicate an informed decision, they will follow the direction of the HPOA. The power of this document eliminates the need to have a public court hearing in which you and others might engage in stressful, wrenching arguments about what decision is the right one for your loved one.
Recently some states have broadened the application of “medical” directives so that an HPOA can also make decisions about such things as admission to assisted living or nursing home facilities. These were not traditionally seen as being “medical” decisions per se, but can be very valuable as a practical matter. Newer documents will typically use the term “healthcare” decisions instead of “medical” decisions.

Your HPOA can decide things for you such as:

  • Which doctors you see
  • What treatments and care you receive
  • Whether you reside at home or in a facility
  • Depending on your state’s rules, an HPOA typically cannot block another person from visiting you unless you add that into the language of the document.

It is crucial to discuss your desires about your healthcare wishes with your HPOA. The HPOA is supposed to be acting for you, as you would act yourself, and not insert his or her own wishes. The HPOA cannot do this job if he or she does not know your wishes. Your HPOA must also have no reservations, religious or otherwise, about honoring your wishes.

Living Will

A Living Will is a document signed by you that states what your wishes would be if you were dying and further treatment would serve only to prolong the dying process. Living Wills usually specify that you wish to have all medications and procedures required to keep you comfortable and pain free, but not treatment to try to cure you. Your Living Will, however, can say whatever you wish. Note that a Living Will has nothing to do with a regular Will (Last Will and Testament), and it is not a Living Trust.

The Living Will got that name because just as with a regular will, where you direct what you want to be done with your belongings, a Living Will directs what you want done with your “self” while you are still living. The Living Will document speaks directly from you to medical personnel when you are in a terminal condition, with no HPOA input. The Living Will can alleviate the stressful burden on the HPOA if he or she were asked whether or not the medical team should keep you on life support when there’s virtually no chance of your recovery.

If you have both an HPOA and a Living Will, (can be two separate documents or they can be combined into an Advance Medical Directive document) and your HPOA tells the doctor to prolong life support despite the provisions of your Living Will, the Living Will trumps the HPOA and medical personnel will follow your directives.

Do Not Resuscitate Order (DNR)

A Do Not Resuscitate Order (DNR) is used when a patient is near death in an emergency situation, usually from cardiac or respiratory arrest. This document is signed at a doctor’s office or in a hospital. People who are extremely ill and/or fragile and are living in their own homes place their DNR in a conspicuous place, such as on the refrigerator. If an ambulance is called, the medical personnel will likely look there to see if CPR, electric heart shocks, or other treatments should be started. A person may also opt to have a DNR bracelet.

Imagine you are terminally ill with a few weeks to live, which may be physically painful or uncomfortable. By that time you are probably under the care of Hospice. If you suffer an emergency, such as a fall, your caregiver would have been instructed not to call 911, but to call hospice instead.

Many patients are incapacitated at the time immediately preceding their death. That means they are unable to make decisions for themselves. Like a Living Will, a DNR trumps any direction from a Healthcare Power of Attorney because it speaks directly to medical personnel. Patients who are being cared for at home while in a terminal condition often notify their local emergency medical personnel that they have a DNR in effect - or their HPOA or family member can make such notification for the patient.

Even if you cannot communicate your wishes, these documents can do it for you.

By: Buckley Ann Kuhn Fricker J.D., GCM, President of Buckley’s For Seniors, LLC

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"'Advance Medical Directives' is the term describing the multiple legal documents that should be completed and submitted to your guardians and healthcare professionals to insure that you are given the treatment and care that you desire."

Healthcare Directives: It’s your decision

Advance Medical Directives ensure your receive the treatment you want when you can no longer express your own needs.

  • Talk to those who you appoint to be your healthcare decision makers (HPOAs) about your wishes; they can’t act for you if they don’t know what kind of care you want.
  • Give copies of your Healthcare Directives to your Doctors and HPOAs.
  • Ensure you have Living Will directives to take the burden of the hard decisions off loved-ones.
  • Consider signing a DNR if you do not want to be resuscitated during an emergency.
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