Preplanning medical decisions is an important task for everyone, especially for the elderly and those in need of hospice. Below are answers to frequently asked questions about advance directives:
Advance directives are legal documents that allow you to plan and make your own end-of-life wishes known in the event that you are unable to communicate. Advance directives consist of (1) a living will and (2) a medical (health care) power of attorney. A living will describes your wishes regarding medical care. With a medical power of attorney you can appoint a person to make health care decisions for you in case you are unable to speak for yourself.
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A living will is an advance directive that guides your family and health care team through the medical treatment you wish to receive if you are unable to communicate your wishes. According to your state's living will law, this document is considered legal as soon as you sign it and a witness signs it, if that's required. A living will goes into effect when you are no longer able to make you own decisions.
A medical power of attorney is the advance directive that allows you to select a person you trust to make decisions about your medical care if you are temporarily or permanently unable to communicate and make decisions for yourself. This includes not only decisions at the end of your life but also in other medical situations. This document is also known as a "health care proxy," appointment or health care agent," or "durable power of attorney for health care." This document goes into effect when your physician declares that you are unable to make your own medical decisions. The person you select can also be known as a health care agent, surrogate, attorney-in-fact, or health care proxy.
You should select someone you trust, such as a close family member or good friend who understands your wishes and feels comfortable making health care decisions for you. You should have ongoing conversations with this person to talk about your wishes at the end of life. Make sure your medical power of attorney feels comfortable and confident about the type of medical care you want to resolve.
Learn about life-sustaining treatments. Life-sustaining treatments are specific medical procedures that support the body and keep a person alive when the body is not able to function on its own. Making the decision about whether or not to have life-sustaining treatments can be a difficult decision depending on your situation.
You might want to accept life-sustaining treatments if they will help to restore normal functions and improve your condition. However, if you are faced with a serious life-limiting condition, you may not want to prolong your life with life-sustaining treatment. The most common end of life medical decisions that you, family members, or an appointed health care agent must make involve:
Cardiopulmonary resuscitation (CPR) is a group of procedures used when your heart stops (cardiac arrest) or breathing stops (respiratory arrest). For cardiac arrest the treatment may include chest compressions, electrical stimulation or use of medication to support or restore the heart's ability to function. For respiratory arrest treatment may include insertion of a tube through your mouth or nose into the trachea (wind pipe that connects the throat to the lungs) to artificially support or restore your breathing function. The tube placed in your body is connected to a mechanical ventilator.
A Do Not Resuscitate (DNR) order is a written physician's order that prevents the health care team from initiating CPR. The physician writes and signs a DNR at your request or at the request of your family or appointed health care agent if you do not want to receive CPR in the event of cardiac or respiratory arrest. The DNR order must be signed by a doctor; otherwise, it cannot be honored. DNR orders:
When you request a DNR order, your physician may ask if you also wish to have a "do-not-intubate" order. Intubation is the placement of a tube into the nose or mouth in order to have it enter your windpipe (trachea) to help you breathe when you cannot breathe adequately yourself. Intubation might prevent a heart attack or respiratory arrest.
Refusal of intubation does not mean refusal of other techniques of resuscitation. If you do not want mechanical ventilation (breathing), you must discuss intubation because it may be included as part of a DNI order. Even if you have completed a DNR order that does not mean that you have refused to be intubated. If you do not want life mechanically sustained, you must discuss your decision about intubation with your doctor.
Artificial nutrition and hydration are treatments that allow a person to receive nutrition (food) and hydration (fluid) when they are no longer able to take them by mouth. This treatment can be given to a person who cannot eat or drink enough to sustain life. When someone with a serious or life-limiting illness is no longer able to eat or drink, it usually means that the body is beginning to stop functioning as a result of the illness.
Some health care professionals may choose to ignore what is written in your living will if they believe that what is written is against your best interest or for moral or religious reasons. In some cases there may be a misunderstanding of the law, medical ethics or professional responsibilities. It is important for you to know if your doctor will honor your request. Bring your complete living will to your next health care appointment and ask your doctor if he or she has questions or concerns.
If you are unable to make decisions, health care professionals must consult your family members. Some states have decision-making laws to identify individuals who may make decisions on your behalf when you do not have an advance directive, such as your spouse, parent or adult children.
Some states may include you wishes about whether you want to be an organ donor as part of the advance directive. If it is not included, you can still write down your decision about organ donation. However, you should fill out a specific form for that purpose. You should also let your loved ones know if you wish to be buried or cremated.
You can fill out a living will and medical power of attorney form without a lawyer. It is very important that you use advance directive forms specifically created for your state so that they are legal. Read the forms carefully and make sure you follow legal requirements determined by your state. You may need to have a witness signature and get the forms notarized (signed by a notary public).
Keep your completed advance directive in an easily accessible place and give photocopies to your primary medical power of attorney and your secondary, alternate agent. This document stays in effect unless you cancel it or decide to complete a new one with changes.
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