1. What is an "advance directive?"
An advance directive is a written document in which you specify what type of
medical care you want in the future should you lose the ability to make
decisions.
2. Must I have an advance directive?
No. The decision to have an advance directive is purely voluntary. No family
member, hospital or insurance company can force you to have one, or dictate
what the document should say if you decide to write one.
3. Are there different types of advance directives?
Yes. Two types are a durable power of attorney for health care and a living will.
4. What is a "durable power of attorney for health care?"
A durable power of attorney for health care, also known as a health care proxy, is a document in which you give another person power to make medical
treatment and related personal care decisions for you.
5. Is a durable power of attorney for health care legally binding?
Yes, in most states- check with a hospital near you to be sure.
6. Who is eligible to have a durable power of attorney for health care?
You must be at least 18 years old and of sound mind.
7. What is the person to whom I give decision making power called?
The person is known as a "patient advocate".
8. When can the patient advocate act in my behalf?
The patient advocate can make decisions for you only when you are unable to
participate in medical treatment decisions.
9. Why might I be unable to participate in medical treatment decisions?
There might be a temporary loss of ability to make or communicate decisions,
if one were knocked unconscious in a car accident or had a stroke. There
might be a long term or permanent loss through a degenerative condition such
as Alzheimer's Disease.
10. Who determines that I am no longer able to participate in these decisions?
The doctor responsible for your care and one other doctor will make that
determination.
11. What powers can I give a patient advocate?
You can give a patient advocate power to make those personal care decisions
you normally make for yourself. For example, you can give your patient
advocate power to consent to or refuse medical treatment for you, to
contract for home health care or adult day care, arrange care in a nursing
home or move you to a home for the aged.
12. Can I give my patient advocate the right to make decisions to withhold or withdraw life sustaining treatment?
Yes, but you must express in a clear and convincing manner that the patient advocate is authorized to make such decisions, and you must acknowledge
these decisions could or would allow your death.
13. Can I authorize my patient advocate to decide to withhold or withdraw food and water administered through tubes?
Yes. If you wish to give your patient advocate power to have tube feeding
withheld or withdrawn in the event you become terminally ill or permanently
unconscious, you should state this in the document or in a living will.
14. Do I have the right to express in the document my wishes concerning medical treatment and personal care?
Yes. You might, for example, express your wishes concerning the type of care
you want during terminal illness. You might also express a desire not to be
placed in a nursing home and a desire to die at home. Your patient advocate
has a duty to try to follow your wishes.
15. Is it important to express my wishes - either in the durable power of attorney for health care or in a separate living will?
It may be. Your wishes cannot be followed if no one is aware of them. It can
also be a great burden for your patient advocate to make a decision for you
without guidance.
16. Who may I appoint as patient advocate?
Any person age 18 or older is eligible. Obviously, you should choose someone
you trust, who can handle the responsibility, and who is willing to serve.
17. Does a patient advocate need to accept the responsibility before acting?
Yes, he or she must sign an acceptance. This does not have to be done at the
time you sign the document. Nevertheless, you should speak to the person you
propose to name as patient advocate to make sure he or she is willing to
serve.
18. Can I appoint a second person to serve as patient advocate in case the first named person is unable to serve?
Yes.
19. What if I have no one to appoint as patient advocate?
You can still complete a living will.
20. What is a "living will?"
A "living will" is a written statement in which you inform doctors
and family members what type of medical care you wish to receive should you
become terminally ill or permanently unconscious, and unable to make or
communicate decisions about your continued care.
21. What are the differences between a durable power of attorney for health care and a living will?
The focus of a durable power of attorney for health care is on who makes the decision; the focus of a living will is on what the decision is. Also, a
living will is limited to care during terminal illness or permanent unconsciousness; a durable power of attorney for health care can be applicable during temporary
disability.
22. What might a living will say?
You might express your wishes in general terms - "Do whatever is necessary for my comfort, but nothing further." Or, "I authorize
all measures be taken to prolong my life." You might express desires about the use of specific medical interventions, such as a respirator,
cardiopulmonary resuscitation (CPR), surgery, and blood transfusions. You could authorize experimental or non-traditional treatment.
You should express your wishes concerning food and water administered through
tubes.
23. Is a living will legally binding?
Not all states have laws giving living wills legal force. Ask a hospital in
your state to find out if yours does. If your state doesn't, then doctors
and hospitals might comply with your wishes, but no one can provide absolute
assurance.
24. Can I have both a durable power of attorney for health care and a living will?
Yes. You could have a single document or two separate documents. If in separate documents, you should make sure your wishes expressed in the two are consistent. If in a single document, you should comply with the technical
requirements of the durable power of attorney for health care law.
25. In general, what should I do before completing an advance directive?
Take your time. Consider who you might choose to be your proxy. Think about
your treatment wishes. Discuss the issue with family members and your
doctor. Talk with your minister, rabbi, priest. or other spiritual leader if
you feel it would be helpful.
26. Are there issues I should give particular attention to?
Yes. Many people have strong feelings about the administration of food and
water. If you are unable to swallow, food and water can be supplied by a
tube down your throat, a tube placed surgically into your stomach. or
intravenously. Consider in what circumstances, if any, you would have such
procedures withheld or withdrawn.
27. To have an advance directive, what forms would I use?
You may use a form put out by a hospital or other organization, you may hire
a lawyer to draft the document or documents, or you may write the entire
document yourself. If you write the entire document, type it or print so it
is legible.
28. What are the technical requirements of a durable power of attorney for health care?
The declaration must be in writing, signed by you, and witnessed by two adults. There must be a written acceptance by the proxy, in language set forth in
the law. There are restrictions on who can be a witness, as indicated on the form.
29. What are the requirements for a living will?
It is strongly recommended the document be entitled "LIVING WILL;"
be dated; signed by you; and signed by two witnesses.
30. What is the purpose of having witnesses?
If there is a dispute later, witnesses can testify that when you signed the document, you knew what you were doing and were not being pressured by anyone.
31.What should I do with an advance directive after it is signed?
Give the original of a durable power of attorney for health care to the patient advocate (or at least make sure he or she knows where it is). Give a
copy to your doctor and keep a copy yourself. Keep the original of a living will. Give a copy to family members who are close to you, a friend
and your doctor. Keep a list of these people. Have the doctor make the document or documents part of your medical record. If you enter a hospital
or nursing home, try to see to it that the facility has a copy.
32. When should I review an advance directive?
Since medical technology is constantly changing, and since there may be
changes in your outlook, it would be wise to review an advance directive
once a year. Upon review, you can decide to keep the document, write a new
one, or have no advance directive at all. If you decide to keep the advance
directive, you can put your initials and the date on the bottom.
33. What should I do if I write a new advance directive?
Whether you choose a different person to be patient advocate or alter your
wishes for care, try to get back all copies of the old document and destroy
them. Distribute copies of the new document.
34. What if I change my mind but don't have the opportunity to write a new advance directive?
An advance directive can always be revoked by giving any indication the document does not reflect your present wishes.
35. Must a hospital or nursing home comply with the directions of my patient advocate?
Federal law requires hospitals, nursing homes and other health care
providers that receive federal funds to inform incoming patients of their
rights to consent to or refuse treatment, including their rights under state
law to have advance directives. If the hospital or nursing home has no
reason to question the document's authenticity, believes the patient is no
longer able to participate in medical treatment decisions, and feels the
patient advocate is acting consistent with the patient's expressed wishes,
the institution would probably have to comply.
36. Are health care proxies applicable in a home setting?
Yes.
37. If I have an advance directive, when would it take effect?
Under the terms of the durable power of attorney for health care, the patient advocate has power to make decisions for you if and when you become unable
to make medical treatment decisions. A living will only takes effect if two conditions are met: 1) you become terminally ill or permanently unconscious,
and 2) you become unable to participate in medical treatment decisions.
Remember
whenever discussing legal issues in nursing it is
imperative to review your state's Nurse
Practice Act.
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