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The Importance of Advanced Directives

advanced directives end of life

The Importance of Advanced Directives

End-of-life decisions are often mentioned in casual conversations with friends or co-workers, but most people don’t actually see the importance of advanced directives and put their wishes in writing until they are forced to.  Decisions you might make while being admitted to a hospital for surgery might not be the same as those you’d make if you had more time to think them over. I’ve heard it compared to the pressure of buying a used car – just make a choice and hope for the best.

Advanced Directives are decisions that you make about the treatment you would like if you suffer a life-ending event such as a heart attack.  The ideal time to make choices about your healthcare is when you are able to make competent, informed decisions.  You have the opportunity to consider all of the treatment options and decide exactly what you would or wouldn’t want done if you have no chance for recovery.  Whether you want to take advantage of every life-saving measure available or would prefer that the doctors allow you to expire naturally is up to you.  There will be no question as to what treatments you want done and whom you would prefer to make decisions.  You can complete Advanced Directives on your own, or you can make an appointment to discuss the treatment options with your doctor.  Most doctors welcome such discussions and will explain the treatment options in detail so that you fully understand the choices you can make about your healthcare.

If there are no Advanced Directives on file, each state has a law that addresses the succession of decision-makers (known as “next of kin”) on a person’s behalf.  Although this covers family relationships, it doesn’t address people who live together and aren’t married, close friendships, and any number of other possibilities.  Without an Advanced Directive, the person who is next in line will have to make those decisions without your input.  Completing Advanced Directives ensures that your voice will be heard when it’s needed the most.

It’s important to remember that a Will, or Last Will & Testament, is a document that designates who will receive the patient’s property after he dies and has nothing to do with the patient’s healthcare choices.  An Estate Plan, or Living Trust, might possibly include healthcare directives.  It depends on who prepares the documents as to what an Estate Plan includes.

There are many different types of Advanced Directives.  They can be found separately or can be combined into one form.  The ones most generally used to make healthcare decisions are:

Durable Powers of Attorney for Health Care (DPOA) – a type of Advanced Directive that designates the person that the patient wants to make decisions if he is unable to make informed decisions on his own.  It is always best to name one person as P.O.A., and alternates if he/she isn’t able to perform.

Do Not Resuscitate Order (DNR) – an Order that is given by a Physician that directs the medical staff to allow the patient to die if his heart stops beating or he stops breathing.

Living Will – a form that a person completes to tell Medical Providers what type of care he would like if he has no likelihood of recovery.  Most modern Living Wills give the patient the opportunity to choose which of the treatment options they would prefer, such as CPR, Intravenous Fluids and Antibiotics, placement on a Ventilator, etc.

Medical Treatment Plan – a form that a doctor completes with a patient developing a Plan of Care in case the patient has no likelihood of recovery.

Organ Donation – a decision made by patients regarding donating their organs if they die.  In addition to having permission from the patient, hospitals must have written permission from the legal next-of-kin.

Advanced Directives should be reviewed at least every two years.  Situations change and it’s possible that the Healthcare Power of Attorney you chose is no longer able to make decisions, or that he/she is no longer the person that you wish to speak for you.  This could be due to divorce, family circumstances, or the healthcare status of the Power of Attorney.  Illness might also cause a change in the treatment choices – a patient with a potentially life-ending illness might change his directives after speaking with his doctor about whether the benefits of certain treatments outweigh the risks.

Each state offers Advanced Directive forms that you can easily download and complete without requiring legal advice.  The forms must be notarized or witnessed in accordance with state law or the documents aren’t legal.  In most cases, the forms can’t be witnessed by the person named Power of Attorney, a family member of the patient, a healthcare provider or a person named in the patient’s Will.  The form will clearly state who can be a witness.  Once completed, copies should be given to the treating physician and hospital, the designated Power of Attorney, and to other family members or friends so that there will be no question as to how you wish to be treated.


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