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Advance Care Planning: Ways to Plan Ahead for Health Care

Let's face it: we never know when we might need medical care and treatment. For some people, deciding the issues and tackling the choices at the time care or treatment is needed is sufficient, but others may need to plan ahead through the use of livings wills, do not resuscitate orders (DNRs), durable powers of attorney, or other types of advance directives.

Advance Directives: The Basics

An advance directive is a document used to tell your physicians what kind of care you would like to have if you're unable to make these decisions for yourself, such as if you are in a coma. Advance directives can provide direction on what kind of care you'd like to receive, what types of treatment you would not like to have, and your preferences regarding artificial life support.

Once a doctor receives a properly executed advance directive, they must either honor its instructions or transfer your care to a physician who will. The three main types of advance directives include livings wills, durable powers of attorney, and DNRs.

What is a Living Will?

A living will is a legally binding document that comes into effect when you're terminally ill or (in some states) whenever you're unable to make decisions for yourself. In most situations, being terminally ill means that you have less than six months to live (per the doctor's prognosis). Living wills are sometimes called "directives to physicians" or "health care directives."

While a living will allows you to describe in advance the kind of treatment you want (or don't want) to receive, it doesn't allow you to appoint a person to make medical decisions on your behalf. For that, you'd need a durable power of attorney.

What is a Durable Power of Attorney for Health Care?

A durable power of attorney for health care (or "health care proxy") allows you to make decisions as to what type of care you would like to receive in the future, similar to a living will. But a durable power of attorney also allows you to select a family member or other trusted individual to make medical decisions on your behalf (called the "health care agent" or "surrogate") if you're unable to do so yourself.

You can give your surrogate as much or as little power as you'd like. For example, your durable power of attorney can state that the surrogate may decide when treatment should be stopped. Or, the document may indicate that they may determine the types of treatments you receive, but can't stop those treatments once they have begun.

When deciding on a health care agent, make sure that they'll respect your wishes, even if they may not agree with them. Make sure, also, that the person you appoint is sensitive to the feelings of others who may not agree with your plans, but also assertive enough to carry out your wishes. Check the laws of your state for specifics.

What is a Do Not Resuscitate Order (DNR)?

DNRs are advance requests not to have cardiopulmonary resuscitation (CPR) or advance cardiac life support (ACLS) if your heart stops or you stop breathing. DNRs are important for those who don't want to have this potentially life-saving measure taken because, unless given contrary instructions, hospital staff will try to revive non-responding patients.

To create a DNR, you can either use an advance directive form or you can clearly tell your doctor that you don't wish to have CPR or ACLS performed. In the former case, your doctor should make a conspicuous note in your medical chart. It's important, however, that a DNR created in this way be made at a time early in your hospitalization when your competency is not in question.

Benefits of Advance Care Planning

With an advance directive, you may experience a sense of relief knowing that you won't be subjected to unnecessary or personally objectionable treatment. Without one, you may have to rely on the discretion of your physician to make decisions for you about your health care. Also, having an advance directive may save your loved ones anxiety, concern, and arguments.

Advance care planning, the durable power of attorney in particular, can give you the power to choose who can make decisions on your behalf. This can benefit those with a very strong relationship with a friend, or unmarried partners. Such individuals, although important to you, would in other circumstances most likely be barred from participation.

Advance Care Planning: Important Considerations

Make Updates as Needed

In drafting an advance directive, realize that medical choices and treatments available today may be unavailable in the future. You'll either need to update your directive as new developments in medical technology and treatment become available or draft your directive in such a way that newly developed treatments aren't excluded.

Specify Pain Treatment Preferences

Most state laws presume that people want relief from pain, so those items are not included in the definition of "life-prolonging treatment." If you don't want to receive pain medications, you should make that clear in your directive. The same goes for food and water in some states.

Consider All Possible Scenarios

Making sure that your advance directive protects your wishes is the most difficult task. For example, have you thought about whether you want life-prolonging treatments, no matter what your quality of life might be? Would you rather not have treatment if it means it could keep you alive, but in a permanent coma? What if you couldn't feed yourself? Breathe on your own? Would you want to have life-saving treatments for a short period of time, or not at all?

Talk to Your Doctor

In many situations, including your physician or health care provider in the process of discussing your treatment wishes is a good idea. If you have a terminal illness, your physician can review your diagnosis with you and provide essential advice on what types of treatment you're likely to need, and the effect those treatments might have.

Legal Requirements for Advance Directives

As with other health care related matters, living wills and durable powers of attorney are governed at the state level. However, most states have the following legal requirements:

  • You must be 18 (some states allow parents to draft advance directives for their minor children);
  • You must be capable of understanding what the document means, what it contains, and how and when it applies;
  • You can change your mind, but you should destroy all copies of any old directives and write a new one instead of trying to "amend" or "add to" the original directive; and
  • The directive must be signed in the presence of either a witness, a notary public, or both.

Get Professional Legal Help With Advance Care Planning

Few things are as important as one's health and it's important to prepare for the inevitable end at some point. With the right advance care planning, you can ensure that your wishes are respected and that your family is spared the anxiety of making critical decisions without any guidance from you. If you need help planning ahead for your health care needs, reach out to an experienced health care law attorney near you.

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