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What are advanced directives?
What is a living will?
When
does it apply?
What treatments are covered?
Who can complete a living will?
Can a living will be revoked?
What is a durable power of attorney for
healthcare?
When does a durable power of attorney for
healthcare take effect?
What treatments are covered?
Who can be named as an agent?
Who can complete a durable power of
attorney for healthcare?
Can more than one agent be named?
Can a durable power of attorney for
healthcare be revoked?
How are the living will and durable power
of attorney for healthcare implemented?
What are some other differences between
the durable power of attorney for healthcare and the living
will?
How do health professionals know if a
patient has an advanced directive?
Immunity
Do Not Resuscitate (DNR) Orders
Points to Remember
What are advanced
directives?
Advanced directives are legal documents in which patients
express their wishes about the kind of healthcare they want to
receive should they become unable to make their own treatment
decisions. There are two types of advanced directives: the
living will and the power of attorney for healthcare. Check with
an attorney to find out what is available in your state.
What is a living will?
A living will is a legal document in which patients are able to
state in advance their desire to receive, or to withhold,
life-support procedures when they are permanently unconscious or
terminally ill and unable to make informed decisions.
When does it apply?
The living will applies only when two doctors determine that the
patient is either in an irreversible coma or is suffering from a
terminal illness and is unable to make decisions for
him/herself. As long as a patient is able to make healthcare
decisions, the living will cannot be used.
What treatments are
covered?
The living will permits the withholding or withdrawal of any
treatment that might be considered life-prolonging or that
artificially extends the dying process. Some states have special
provisions that allow artificial nutrition and hydration to be
withheld or withdrawn when patients are in an irreversible coma.
Who can complete a
living will?
Anyone over the age of 18 years who is of sound mind can
complete a living will. To be legal, it must be witnessed by two
adults or can be notarized.
Can a living will be
revoked?
A living will can be revoked by the patient at any time and in
any manner, with the patient simply tearing up the living will
document, expressing orally to witnesses the desire to revoke
the document, or in writing. Healthcare professionals who
witness such revocations will document them in the medical
record.
What is a durable power of attorney for healthcare?
The durable power of attorney for healthcare is a document that
allows patients to specify in advance who should make healthcare
decisions for them should they become unable to make their own
health care decisions. The individual named is the agent or
attorney-in-fact for the patient.
When does a durable power of attorney for healthcare take
effect?
The durable power of attorney for healthcare takes effect
anytime the patient loses the ability to make his or her own
healthcare decisions. Unlike the living will, the patient does
not need to be terminally ill or suffering from an irreversible
coma.
What
treatments are covered?
The durable power of attorney for healthcare document allows a
patient to name an agent or attorney-in-fact with broad or
specific powers to provide consent or refusal for any type of
health care. Durable powers of attorney for healthcare are very
flexible documents, allowing both the naming of an agent to make
decisions for the patient when the patient is unable to do so,
and the specification of the treatments that the patient wants
or does not want to receive.
Who can be named as an
agent?
Anyone over the age of 18 years can be named as the agent except
for the doctor (or those employed by the doctor) who is
providing care to the patient. The agent named has no legal
obligation to serve and the agent is not responsible for the
financial costs associated with treatment.
Who can complete a durable power of attorney for healthcare?
Any adult of sound mind may complete a durable power of attorney
for healthcare. Living wills and durable powers of attorney for
healthcare are often prepared without the assistance of lawyers
by using standard forms. The durable power of attorney for
healthcare document must be witnessed by two adults or
notarized. Such documents and procedures vary by state.
Can more than one
agent be named?
Only one agent can serve at a time, but other individuals can be
named as successor agents if the first individual named as the
agent is not able or is unwilling to serve.
Can a durable power of attorney for healthcare be revoked?
The patient can revoke a durable power of attorney for
healthcare at any time and in any manner by simply tearing up
the durable power of attorney for healthcare document,
expressing orally to witnesses the desire to revoke the
document, or in writing. Healthcare professionals who witness
such revocations should document them in the medical record.
How are the living will and durable power of attorney for
healthcare implemented?
Both documents require that two doctors determine that the
patient has lost the capacity to make healthcare decisions. A
living will has the additional requirement that the patient must
be suffering from a terminal condition or is in an irreversible
coma.
What are some other differences between the durable power of
attorney for healthcare and the living will?
The living will simply requires the withholding or withdrawal of
life-prolonging treatment whereas the durable power of attorney
for healthcare names a specific agent who is authorized to make
decisions for the patient. Specific instructions may be given to
the agent in the durable power of attorney for healthcare, but
they are not required.
How do health professionals know if a patient has an advanced
directive?
Many hospitals and clinics will ask the patient or family upon
admission about the existence of advanced directives when they
are admitted to the hospital. The existence of an advanced
directive is documented prominently in the medical chart. Also,
health professionals should document the content of discussions
about the patient's end-of-life desires or any expression of
treatment preferences.
Immunity
Physicians and healthcare providers are immune from civil,
criminal, and disciplinary action if they follow the advanced
directive statute in good faith and meet its provisions.
Do Not Resuscitate
(DNR) Orders
Advanced directives are not DNR orders. DNR orders are written
by doctors to indicate that a patient should not be
resuscitated. The order may be written to reflect a patient's or
surrogate's expressed wishes about resuscitation, or because the
patient will not benefit from resuscitation. For example, for
someone with a living will or durable power of attorney for
healthcare, CPR may be appropriate if they are suffering from an
acute life-threatening condition. Patients with advance
directives may want aggressive treatment for potentially
reversible conditions.
Points to Remember
Advanced directives only take effect when the patient loses the
ability to make his or her own decisions. Before that time, the
patient's current expressed wishes should be followed.
Advanced directives do not replace active communication with
patients and their families. Patients and families should be
provided appropriate and sufficient information to make informed
healthcare decisions. Patients' expressed preferences about
healthcare treatments should be documented as they evolve in the
course of treatment.
Assessing and attending to patients' spiritual needs are
important in quality end-of-life care and should be a routine
part of patient care.
Quality medical care also includes providing patients with a
supportive atmosphere in which to reflect on end-of-life choices
and to allow their wishes to be communicated to their healthcare
providers and to their families.
ADVANCED DIRECTIVES
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