For example, people have the legal right to make their own health care decisions. A health care power of attorney appoints a person called a health care agent or proxy, health care representative, or other name depending on the state to make decisions for the person the principal in the event of incapacity temporary or permanent to make health care decisions.
Normally, people communicate their wishes directly to their doctors. But when a person no longer has the capacity to make or communicate a health care decision, another way to make and communicate a decision is needed. That is the role advance directives play. If no advance directive has been prepared, someone else recognized by state law or appointed by a court may be called on to make health care decisions.
Many states authorize default surrogate decision makers Default Surrogate Decision Making If a person is unable to make decisions about personal health care, some other person or people must provide direction in decision making. The general term for such person is surrogate decision When state law does not authorize a default surrogate decision maker, doctors and hospitals still usually turn to next of kin, although the extent of their legal authority becomes less clear.
In the rare event that the issue is referred to a court, courts generally prefer to name a family member as guardian or conservator to make health care decisions, but they may also turn to a friend or a stranger to direct care. In many states, the document is more formally called a medical directive to doctors or a declaration. The focus of a living will is usually end-of-life care, but it can include instructions about any aspect of care or treatment.
Living wills become effective only when the person has lost capacity to make health care decisions and the person has a particular condition defined by state law—usually a terminal condition or permanent unconsciousness. Some states recognize additional conditions such as an end-stage condition for example, advanced Alzheimer disease or any condition specified in the living will.
Many people believe that death is preferable to being perpetually dependent on medical equipment or having no hope of returning to a certain quality of life. Others feel just as strongly that extreme heroic measures and technology should be used to extend life as long as possible, regardless of the degree of medical intervention required or the quality of life that results.
A living will allows a person to express either of these preferences or any intermediate measure that the person finds acceptable. Including information in a living will about core values relating to end-of-life care, personal priorities, and goals of care can be just as helpful, if not more so, than specific treatment wishes, because most specific treatment decisions are unforeseeable.
To be legally valid, a living will must comply with state law requirements such as those regarding how the document is signed and witnessed or what must be included in the text of the document. Many states have specific forms available for people to use if they choose. People can usually find examples of acceptable forms from hospitals and other health care practitioners, local offices on aging, or law bar association web sites.
Typically, living wills address the issue of when the goals of treatment should change from aggressive, curative efforts to efforts that primarily provide comfort care and allow a natural death.
Advance Directives Advance directives are a way of making sure that your wishes and values are respected in important decisions especially health care decisions made for you when you are no longer able to make such decisions for yourself. In Fleming v Reid , the Ontario Court of Appeal stated: A patient, in anticipation of circumstances wherein he or she may be unconscious or otherwise incapacitated and thus unable to contemporaneously express his or her wishes about a particular form of medical treatment, may specify in advance his or her refusal to consent to the proposed treatment.
A doctor is not free to disregard such advance instructions, even in an emergency. It is also important to know that provinces and territories may allow you to say in advance what medical treatment, preventive care, and other personal care you want and do not want this may include artificial hydration and nutrition or oral feeding and liquids.
All situations? Would you want treatment only if a cure is possible? You should address a number of possible end-of-life care decisions in your living will.
Talk to your doctor if you have questions about any of the following medical decisions:. You don't need to have an advance directive or living will to have do not resuscitate DNR and do not intubate DNI orders. He or she will write the orders and put them in your medical record. Even if you already have a living will that includes your preferences regarding resuscitation and intubation, it is still a good idea to establish DNR or DNI orders each time you are admitted to a new hospital or health care facility.
Advance directives need to be in writing. Each state has different forms and requirements for creating legal documents. Depending on where you live, a form may need to be signed by a witness or notarized.
You can ask a lawyer to help you with the process, but it is generally not necessary. Review your advance directives with your doctor and your health care agent to be sure you have filled out forms correctly. When you have completed your documents, you need to do the following:. You can change your directives at any time.
If you want to make changes, you must create a new form, distribute new copies and destroy all old copies. Specific requirements for changing directives may vary by state. You should discuss changes with your primary care doctor and make sure a new directive replaces an old directive in your medical file. New directives must also be added to medical charts in a hospital or nursing home. Also, talk to your health care agent, family and friends about changes you have made.
In some states, advance health care planning includes a document called physician orders for life-sustaining treatment POLST. This form does not replace your other directives.
Instead, it serves as doctor-ordered instructions — not unlike a prescription — to ensure that, in case of an emergency, you receive the treatment you prefer. You can accept or refuse medical care.
You might want to include instructions on. A durable power of attorney for health care is a document that names your health care proxy. Your proxy is someone you trust to make health decisions for you if you are unable to do so. The information on this site should not be used as a substitute for professional medical care or advice.
Contact a health care provider if you have questions about your health.
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