An Advance Health Care Directive? No Thanks!

Here we are again, talking about something we all do our very best to avoid even thinking about: end-of-life choices.

Let us remind ourselves that planning and preparing for the inevitable – our own deaths – does not, in any way,  hasten the arrival of the Reaper or invite disaster.  It is not morbid or gloomy or pessimistic to prepare our families and loved ones for the future – it’s thoughtful and considerate, and hugely appreciated in stressful times.  Imagine that you are terminally ill or gravely injured and unable to communicate.  Think how frightened those around you will be.  Having a set of directions to guide them would be such a help.

And that is exactly what an Advance Health Care Directive (AHCD) is: a set of directions that instructs others about your medical care and treatment should you be unable to make the decisions yourself.  That’s it.

The document becomes effective only under circumstances set out in the form itself, and allows you to do either or both of the following:

• Appoint a health care agent: The AHCD allows you to name a health care agent (also called a ‘durable power of attorney for health care‘, a ‘health care proxy‘, or an ‘attorney-in-fact‘), the person who will have the legal authority to make health care decisions for you should you be incapacitated.  This agent is typically a spouse, but could be another family member, a friend or someone you believe will see that your wishes are respected.  This person will have the authority to make decisions regarding artificial nutrition and other life prolonging measures, or not.
• Set out instructions for health care: The AHCD offers you a way to prepare specific written instructions for your future health care in the event of a situation in which you cannot speak for yourself.  You can outline your wishes about life-sustaining medical treatments if you are terminally ill, or permanently unconscious.  Also known as a ‘living will‘.

Some of the main misunderstandings and questions about AHCD’s include:

• Must you have an Advance Health Care Directive form to stop treatment near the end of life? No.  Treatment can be stopped without a directive if everyone involved agrees.  If there are disputes or disagreements, however, decisions get trickier.  This is where a directive is really helpful.
• If I name a proxy, do I give up the right to make my own decisions? Again, no.  You always have the right, while you are still competent, to override any decisions make by your proxy.  You may also revoke the directive.  Naming an agent does not take away any of your authority.
• Does an advance directive mean ‘do not treat’?  Your directive can detail both what you want and what you don’t want.  And even if you do not want treatment to cure you, you still have access to treatment to relieve pain and discomfort.
• Aren’t these directives really only for the very old?  Think about that for a minute.  A younger adult actually has more at risk here.  A bad accident or serious disease could keep a younger victim alive but insentient  for many years, especially given medical advances today.  So all of us over 18 should organize a directive.
• Shouldn’t I wait until I am sure what I want before preparing a directive? Just get one started.  You can always alter it should you change your mind about something later on.  Think of it as part of a process and not a stone-chiseled document.

AHCD’s and living wills are not complicated instruments, but do need careful thought.  And while you are not required to use an attorney to prepare one, it would be a very good idea to do so.  You want to be sure that your personal instructions are accurately stated.  To be enforceable, the document must be clear.  Laws regarding AHCD’s differ among the states, so learn what applies where you live: State Laws.

Before we go into more how-to’s with AHCD’s, you will want to have a look at a form.  The directive forms for your state are available through one of the following:

• State healthcare association website
• Attorneys handling wills, probate, estates and elderlaw matters
• Geriatric care managers
• Community and senior services organizations
• Hospitals and hospice programs

Next up: what to include, where to keep it, how to change it…