Advance Directive – Can be a Gift to Loved
Ones
What are Advance
Directives?
What is a living will?
What is a medical power of attorney?
What is a CPR directive?
Why do I need an advance directive?
What laws govern the use of an advance directive?
By Deanna
S. Bond, CMSC
Director Marketing and Medical Staff Services
A standard
question asked all patients who present for inpatient and outpatient
hospital treatment is "Do you have an Advance Directive?"
Each time I am asked this question I am a little taken back and
shaken by the fact that yes, this is the real world and the young
as well as the old are faced with the reality that there may come
a time when they may not be able to tell others what type of medical
care they would prefer to have. This potential communication difficulty
may be temporary, or it may be ongoing. As much as I would like
to discount myself from this realization, it is a decision we
all must face and one, which could take unnecessary pressure off
of family members in a life and death situation. When a person
is being admitted to a health care facility, it seems like a dreadful
time to bring up the topic of advance directives and the information
is handed to the patient and family in probably the most psychologically
worst moment. That is, of course, unless the patient has prepared
ahead of time and documented their wishes concerning personal
health care choices.
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What
are Advance Directives?
"Advance
Directive" is a general term that refers to your oral and
written instructions about your future medical care in the event
that you become unable to speak for yourself. In the State of
Colorado the following kinds of medical directives are recognized:
the "living will" (which applies in cases of terminal
illness); the "medical durable power of attorney" (which
allows your named agent to make decisions for you if you become
unable to make them; and a "CPR Directive" (which tells
emergency and other personnel not to do CPR on you).
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What
is a living will?
A living
will is a type of advance directive in which you put in writing
your wishes about medical treatment, should you be unable to communicate
at the end of life.
Your living
will does not go into effect until two doctors agree in writing
that you have a terminal condition, as defined by Colorado law.
Your right to accept or refuse treatment is protected by constitutional
and common law.
Two witnesses
must sign your living will. Your doctor, lawyer, health care facility,
other health organizations or an office supply store may have
living will forms for you to complete. Legal assistance is not
required to complete a living will. If you have legal questions
you may want to talk with a lawyer.
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What
is a medical power of attorney?
A medical
power of attorney is a document that enables you to appoint someone
you trust to make decisions about your medical care if you cannot
make those decisions yourself. This type of advance directive
may also be called a "health care proxy" or "appointment
of a health care agent." This individual stands in for you
when it is time to make medical decisions with your doctor.
A medical
durable power of attorney can cover more health care decisions
than a living will and is not limited to terminal illness. Putting
your instructions into your medical durable power of attorney
for your agent to follow tells him or her what you really want.
You can cancel (revoke) your medical durable power of attorney
at any time.
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What
is a CPR Directive?
Resuscitation
is an attempt to revive someone whose heart and/or breathing has
stopped by using special drugs and/or machines or very firm pressing
on the chest. This is often called CPR (which stands for Cardio
Pulmonary Resuscitation). If you have a CPR directive, and your
heart and/or lungs stop, then paramedics and doctors, emergency
personnel or others will not try to press on your chest or use
breathing tubes, electric shock, or other things to get your heart
and/or lungs working again. If you do not have a CPR Directive
there will almost always be an attempt to resuscitate. Hospitals
and nursing homes respond as if all patients want resuscitation
unless they have completed a CPR directive.
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Why
do I need an advance directive?
Advance directives
give you a voice in decisions about your medical care when you
are unconscious or too ill to communicate. As long as you are
able to express your own decisions, your advance directives will
not be used and you can accept or refuse any medical treatment.
But if you become seriously ill, you may lose the ability to participate
in decisions about your own treatment. While it is better to have
a written Advance Directive, oral statements remain important
both on their own and as supplements to written directives.
Although
death comes to everyone, many of us tend to fear its approach
and may avoid confronting the issues surrounding the end of life.
Nevertheless, it is important for each person to document his
or her wishes in writing prior to serious illness, physical or
mental disability. Otherwise, those wishes may not be known and
may not be honored. Not having those desires documented can also
create an unnecessary burden for loved ones.
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What
laws govern the use of advance directives?
Both federal
and state laws govern the use of advance directives. The federal
law, the patient Self-Determination Act, requires health care
facilities that receive Medicaid and Medicare funds to inform
patients of their rights to execute advance directives. All 50
states and the District of Columbia have laws recognizing the
use of advance directives.
For additional
information concerning Advance Directives please contact the Department
of Social Services at Southwest Memorial Hospital: 564-2230.
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