What is an Advance Healthcare Directive?

May 30, 2017

What is an Advance Healthcare Directive?

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Throughout the course of our natural lives, we try to plan as much as we can to ensure our experience reaches its fullest potential. As we grow older and encounter illness or health complications of another variety, it can sometimes become a necessity to plan medical directives ahead of time. Of course, it’s not likely the first thing on our minds, but that’s not to say devising the proper documents in case of dire medical situations is a small task!

It can be a difficult conversation to have, however, organizing someone’s medical wishes and preferences in one place will make the process much less difficult should a medical emergency occur. But what exactly is an advance directive and why would someone need one?

Advance Healthcare Directive: Power of Attorney vs. Living Wills?

In response to advancing medical technology being able to sustain someone’s life in a permanent vegetative state or while comatose, it was understood that further legal rights were needed for people who were still living but unable to make decisions about their own care. The first mention of an advance directive comes from a proposition found in a 1969 law journal from Illinois attorney, Luis Kutner. Drawing on existing estate laws allowing individuals to control property affairs after death, advance directives first came into effect later in December of 1991.

Essentially, the term advanced directive is a broad way to categorize two documents - a living will and their connected medical power of attorney. Both of these will be used to ensure that your medical wishes will be carried out should you be unable to make the decision yourself and appoints an individual to act on your behalf should you be unable to. 

Each state has a different set of regulations governing the use of these documents, allowing them to change accordingly and remain flexible with a person’s state of being or the judgments of their care team. According to your state’s living will laws, this first document is considered legal as soon as the holder of the document and a legal witness signs it. A living will then go into effect once you are unable to speak for yourself.

A medical power of attorney selects a person you trust to make decisions regarding your medical care should you become temporarily or permanently unable to communicate or make decisions for yourself. The directions given by this document can also include decisions to be made at the end of your life, and also in other medical situations. In some cases, a medical power of attorney may also be referred to as a “healthcare proxy,” “appointment of healthcare agent,” or “durable power of attorney for healthcare.” Once a physician determines that someone is unable to make their own medical decisions, this document will go into effect and shifts the decision making power to your selected healthcare agent, surrogate, attorney-in-fact, or healthcare proxy. 

Understanding the Specifics 

Once you’ve got the basics covered, it’s necessary to consider what specifics need to be included. Given a person’s wishes or even their philosophical or religious beliefs, they may have certain limits as to what life-sustaining treatments or specific medical procedures may be used to support and maintain their body. Other considerations for which life-sustaining treatments to use may involve a physician’s official recommendation and how it matches up against the written directives.

In brief, you may want to accept life-sustaining treatments if they will help to restore normal health or even improve your condition. On the other hand, when faced with a life-limiting condition, you may find it reasonable to forgo certain treatments that would make no significant difference in your wellbeing overall. Some of the most common end-of-life decisions that families or legal appointees must make include:

• Artificial Nutrition and Hydration

• Cardiopulmonary Resuscitation (CPR)

• Do Not Intubate Order (DNI)

• Do Not Resuscitate Order (DNR)

Writing these preferences into one’s advance directives can be challenging and can require legal counsel for the most concise outcome. That said, it is still possible for doctors to refuse to honor your advance directives in certain cases. If they believe that what is written goes against your best interest, whether that’s in terms of moral or religious reasons, their medical ethics or professional responsibilities may override your written requests. That said, it’s highly advised that you bring your living will or power of attorney to your next healthcare appointment and ask whether your doctor has any questions about your requests.

We know that dealing with end-of-life issues is challenging and can be a confusing and emotional experience. With that in mind, always be sure to consult professionals versed in elder law and familiar with these legal considerations sooner than later. Getting these documents created and left to sit before they become active is a good way to know the right decisions were made and whether any changes are necessary. Then, you can get back to living a happy, hopefully, less stressful life!

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