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Advance Directives

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Last Updated: 08/07/2013 6:06 pm
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Health care proxy

A health care proxy (or “durable power of attorney for healthcare”) is a document that appoints a single person (not a pair or a committee!) to make decisions for you when you are too ill or impaired, including mentally, to do so. That person will become your “health care agent” (or “patient advocate”). Health care providers must contact your agent and follow the decisions of that person as though they were your own. Wallet-sized versions are available, with room for special instructions and organ donation information, so that it would be among your personal effects in an emergency.

If the idea of having someone make medical decisions for you raises some worries, be assured that:

 

A health care agent begins to make decisions for you only when your doctor affirms that you are not able to do so (for physical or mental reasons).

Your agent can act temporarily, such as when a decision about the course of your surgery must be made, but you regain the right to represent yourself as soon as a doctor deems you able.

Your agent is legally required to follow your wishes, including moral and religious beliefs, and to act in your (and no other person’s) best interests.

You can limit your agent’s authority. For instance, you can stipulate he or she can authorize a blood transfusion, but not authorize an organ transplant.

• An agent cannot decide about artificial nutrition and hydration unless you have specifically indicated your wishes about that (if not, medical specialists will decide).

If a doctor deems you physically and mentally competent to make decisions, you may do so even if they differ from what you told your health care agent.

A divorce or legal separation nullifies a spouse as agent, unless you request in writing he or she continues as such.

Your agent cannot be sued for health care decisions made in good faith.

 

In New York State, anyone over age 18 may appoint an agent by filling out a health care proxy. Similarly, your agent may be anyone over age 18 (but not your doctor or other healthcare provider). You may designate an alternate if your first choice cannot make decisions for you for any reason. It’s best to choose someone who lives reasonably close by. Be sure the person you designate agrees to do so, and talk honestly with them about your wishes. Keep in mind that a loved one or dear friend may not be the best choice; in the midst of distress about your condition, making decisions or carrying out wishes they disagree with could devastate them emotionally.

 

The living will

A living will is your chance to express details about your healthcare preferences (beyond a DNR order). You can—and should—have this document whether or not you want to appoint a health care agent. Medical personnel (and your agent, if you have one) will use it to guide their actions. The living will specifies what kinds of medical interventions you want and don’t want, under what circumstances you want them made or not made, and for how long. Do you want to be on life support for years if you are in a coma? Do you want nutrition but not breathing assistance? What about implanted medical devices, organ removal and transplant, blood transfusion, medications to keep you in a coma during recovery, and a host of other offerings of modern medicine?

How can you know what to ask for or decline? Fortunately, there are organizations, public lectures, videos, websites, and documents to help you. Five Wishes is a good place to start.

 

 

Five wishes

Five Wishes is an eight-page form from the national nonprofit, Aging with Dignity. This document has been accepted by 38 states, including New York, as meeting the legal requirements for a living will. It was created by Jim Towey, who learned, during his dozen years of assisting Mother Teresa with seriously or terminally ill people, that families often aren’t prepared to make medical decisions for a loved one.

Five Wishes comes not just as a blank form but in a user-friendly booklet that guides you through making those decisions. It even provides multiple-choice questions and lists of statements to agree with, decline, or modify to your liking. (The form is $5 online.) The Benedictine Hospital’s presentation included an excellent video about this, provided by Aging with Dignity.

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