By Cheryl Mathieu, Ph.D., M.S.W.
Issues around serious illness and death are not always easy to discuss, but it is easier on everyone if you have an advance directive before the need arises to use one. The media coverage several years ago of Terri Schiavo's case brought the blessing of individuals and families communicating their wishes for end-of-life care more than ever before. Most people have strong feelings regarding the type of medical care they would like to receive or refuse in certain circumstances. An advance directive allows you to clearly state your feelings in a legal document. Studies have shown that while most people believe that having an advance directive is a good idea, less than 10% of the population has actually developed one for themselves.
I urge you, if you have not done so already, to take this opportunity to:
1) Put your health care wishes in an Advance Directive
2) Choose someone to speak for you if you become unable to communicate
An Advance Directive tells your doctor what kind of care you want (or don’t want) if you become unable to make medical decisions (such as if you are in a coma or have advanced Alzheimer’s). They can take many forms, and the laws about them vary from state to state. Be sure you are aware of the laws in your state.
There are of advance directives: a Living Will, a Medical Power of Attorney (POA), and a Do Not Resuscitate Order (DNR). Legal advice is NOT required, although your attorney can also help you prepare one. To write an Advance Directive, you can fill out a form, write your wishes out yourself, use a lawyer, or use a computer software program. Advance directives only take effect when the patient loses the ability to make his or her own decisions. Before that time, the patient's wishes in the moment should be followed.
No matter if you are sick or healthy, young or old, you need an advance directive. It is free (or very inexpensive), fast, and easy. Now is the time to complete one.
Three Types of Advance Directives
A Living Will is a written, legal document that conveys your wishes in the event that you become terminally ill and incapable of communicating. A "Living Will" may indicate specific care or treatment the person does or does not wish to have implemented in the event of a terminal illness. The Living Will takes affect only when two doctors determine that the patient is either in an irreversible coma or is suffering from a terminal illness and is unable to make decisions for him/herself. A Living Will does not allow you to choose someone to make decisions for you if you cannot. A Living Will is not to be confused with a "last will and testament" that distributes assets after a person's death.
A Durable Power of Attorney for Health Care (DPOA) (or Special Medical Power of Attorney) is a legal document that allows you to assign someone you trust (proxy) to make your medical or health care decisions, if you become unable to make and communicate such decisions personally.
It can also pre-specify the type of health care you want to receive in case you are not able to communicate your wishes.
The Durable Power of Attorney for Health Care takes effect anytime you lose the ability to make your own health care decisions. Unlike the Living Will, you do not need to be terminally ill or suffering from an irreversible coma. A DPOA is generally more useful than a Living Will, unless you do not have another person you trust to make decisions for you.
A Do Not Resuscitate Order (DNR) is a request to not have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. A DNR order can be put in your medical chart by your doctor, and needs a doctor’s signature to be valid.
States regulate advance directives differently. Some (but not all) states have laws to cover a patient who hasn't designated someone to make health care decisions. These laws contain a "priority listing" of those who can make decisions for an incapacitated patient. The Durable Power of Attorney for Health Care document must be witnessed by two adults or notarized. Such documents and procedures vary by state. You can change or cancel the Directives any time, as long as you have “capacity” (you understand the consequences of your actions) to do so.
These documents provide for the power to make medically related decisions only and do not imply the power to make legal or financial decisions.
Another alternative, offering a comprehensive document for advance directives, comes from Aging with Dignity, www.AgingwithDignity.org. They provide the Five Wishes document that makes it easier for you to let your doctor, family, and friends know how you want to be treated if you become seriously ill and cannot tell them. Five Wishes is a gift to your family members and friends so that they won't have to guess what you want. It is easy to understand and simple to use. Five Wishes is an approved legal document in most states. Most states consider two witnesses sufficient to make it legally binding. In some states (HI, MO, and NC) the document needs to be notarized. You can purchase a copy of this document for $5.00 online or by mail.
Take Action NOW
NO MATTER YOUR AGE or health status, please take this opportunity to order this document for you and your loved ones, and fill it out. Give copies to your doctor, hospital, and involved family and friends. The process of establishing advance care directives may be difficult for some to think about or discuss. It requires you think about individual priorities regarding "quality of life" and the potential for death. You may want to visit the "On Our Own Terms" website http://www.pbs.org/wnet/onourownterms/resources.html to help focus your thoughts on what decisions you need to make now so that your choices will be followed when the need arises.
Ways to obtain Advance Directive documents:
1) Five Wishes website: http://www.agingwithdignity.org/
or 1-888-5-WISHES (594-7437)
2) Use a form provided by a legal software program or online service
3) Call your health department or state department on aging to get a Free form
For example: The California website for advance directives