Advance Directives are Important
An advance directive written by an IT technician might go something like this, “Unplug the machine, then plug it back in and see if it works.” While quick, easy, and to the point (and funny), advance directives for the rest of us take a little more time and effort to complete. In this week’s tip we address some of the detailed questions and considerations required to create a meaningful advance directive.
First, we should note that an “Advance Directive” is not any one document. It is the overall game plan for your healthcare in the event you become incapacitated. Below are the most common documents that make up an advance directive.
Living Will
A living will includes written instructions about the kind of care you want when you are dying, seriously ill, and/or in a life-threatening medical emergency. Documenting your wishes and discussing them with important people in your life, including your doctor, eliminates the heavy burden placed on those making medical decisions on your behalf when you are unable to speak for yourself. Without your wishes in writing, your loved ones will try to guess what you might want, and that can lead to tremendous guilt and a lifetime of wondering if the right call regarding your health was made. Having your wishes in writing also helps minimize disagreements between others about what you want for your care.
A living will often details when you wish CPR to be performed, whether to place you on a ventilator to keep you alive, and whether to provide artificial nutrition through feeding tubes. It may also detail your wishes regarding pain management, comfort care, and organ donations.
While it may seem like a no-brainer to want to be kept alive at all costs, there may be situations when you might think otherwise. Everyone has different levels of pain tolerance, standards of living, and willingness to be vulnerable. Are you open to more pain if it meant being conscious and having a chance to say goodbye to your family before you die? If you are in an accident and fall into a coma, how long do you want doctors to keep you alive? Would it make a difference if you’ll be paralyzed from the neck down for the rest of your life? Are you willing to have family see you and take care of you while in a paralyzed state? How do your answers change if you’re 85 years old and lived a good life or 45 years old with kids still at home?
Durable Power of Attorney for Healthcare
The durable healthcare power of attorney authorizes a specific healthcare agent (e.g. a family member, friend, doctor, etc.) to make medical decisions on your behalf when you are unable to do so. This may include authorizing or refusing treatment on your behalf. Typically, this authority is given when you are in a coma or otherwise incapacitated. As long as you are capable of making informed decisions on your own, you maintain the right to make healthcare related choices. Under the authority of this document, your health care agent has the same rights as you normally would to receive information about your past and present health condition and treatment options. The decisions you allow your designated healthcare agent to make are also spelled out in this document.
The living will and healthcare power of attorney work together. Without your desires in writing, your agent will have to rely on memory to recall your healthcare wishes, if in fact you ever verbalized them to your agent in the first place. And without a healthcare agent, strangers will decide your physical well-being. Finally, remember that the person you’ve trusted to make these healthcare decisions for you will probably be distraught and worried for you when they are called on to act on your behalf. Having your wishes in writing will give them confidence to make choices according to your desires. It also offers backup in the event that other family members or friends push for different treatment options for you.
HIPAA Release Form
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that required the creation of national standards to protect sensitive patient health information from being disclosed without the patient’s consent or knowledge. Though your healthcare power of attorney should be enough to allow your medical team of doctors and nurses to share information about your condition and care with your designated agent, having a signed HIPAA release form may be a good idea. Healthcare institutions and professionals can be so in tune with following HIPAA laws that they may be reluctant to share information without a specific authorization form. When your life is in jeopardy you don’t want your authorized agent and doctors to be haggling over HIPAA. Work with your attorney and/or your healthcare providers to make sure you have the appropriate paperwork.
