Advance directives generally refer to specific guidelines concerning future medical treatments if a person loses the ability to decide for themselves. Thus, they are legal documents that extend a person’s control over health care decisions if the person becomes incapacitated.
They are called advance directives because they communicate preferences before incapacitation occurs. An advance directive cannot be completed after a patient becomes too incapacitated to understand the nature and effect of an advance directive or to communicate his or her wishes.
it is important to also note that the directive does not become effective until after incapacitation to make health care decisions has been determined. If no advance directive has been prepared, an authorized surrogate appointed by a court may be needed to make health care decisions.
It is good to note that the person giving the advance directive must be of legal age and sound mind to sign such a document. In most cases, they also need one or two witnesses or a notary’s signature and stamp to make the advance directive legally binding.
What are the Purposes of Advance Directives?
The primary purpose of an advance directive is to help family and medical staff carry out the patient’s wishes accordingly. The Patient’s wishes are known and can be followed also:
- It often comforts family members to know what the patient wants.
- It saves family members from having to bring up the subject themselves.
- The patient may also gain peace of mind, making the choices for himself instead of leaving them to his loved ones.
- It can help the patients and their loved ones worry less about the future and live each day to the fullest.
Types of Advance Directives
There are 2 primary types of advanced directives:
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Living Will
A living will is a statement that lists all preferred or unwanted medical treatments and end-of-life care options. This expresses preferences for medical treatment and end-of-life care. It is called a “living” will because it is in effect while the person is still alive.
A living will allows people to express preferences for the amount and nature of their health care, from no interventions to maximum treatment. Detailed treatment preferences can be helpful because they provide more specific guidance to practitioners.
However, living wills completed long before a person experiences a life-limiting disorder have not usually been very helpful because, among other reasons, many people change their preferences as their circumstances change.
A living will go into effect when people are no longer able to make their own healthcare decisions; often a medical condition specified in the directive—typically a terminal condition, permanent vegetative state, or the end-stage of a chronic condition.
Often, state law provides a process for confirming and documenting the loss of decisional capacity and the medical condition.
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Durable Power of Attorney For Health Care
A durable power of Attorney for health care is a document that allows people to name another person to make decisions about their medical care if they are unable to make these decisions for themselves.
It is also called a health care proxy or medical power of attorney for health care. Unlike a regular power of attorney, which is nondurable, a medical power of attorney is always a durable power of attorney.
A nondurable power of attorney expires and is no longer valid if you become incapacitated. Because of this, medical powers of attorney are written to be durable—they don’t come into effect unless you become incapacitated.
People often appoint someone they know well and trust to carry out their wishes. This person may be called a healthcare agent, surrogate, or proxy.
Both common law and constitutional principles direct that any authentic, clear expression of patients’ wishes should be honoured if within the scope of generally accepted medical standards.
In a durable power of attorney for health care, one person (the principal) names another person (the agent, proxy, health care representative, or surrogate) to make decisions about health care and only health care.
These documents become legally effective when the principal loses the clinical capacity to make healthcare decisions
People who have both a living will and a durable power of attorney for health care should stipulate which should be followed if the documents seem to conflict. A common practice is to combine the two documents into the power of attorney.
The strongest virtue of the power of attorney for health care is that it enables a designated decision-maker to respond to here-and-now circumstances and options, rather than merely providing directions about hypothetical future medical circumstances such as those not addressed in a living will.
The agent generally has the same authority the principal would have had if not incapacitated to know the medical facts and prognosis, discuss medical alternatives, and make decisions about any injury or illness.
The durable power of attorney for health care typically names an alternate or successor in case the first-named person is unable or unwilling to serve as an agent. Two or more people may be named to serve together (jointly) or alone (severally), although reliance on multiple concurrent agents can be problematic.
A jointly held power requires that all agents agree and act together in this arrangement; any disagreement can result in a stalemate until it is resolved
The most common types of care addressed by a living will and durable power of attorney are:
- The use of machines to keep one alive. Examples include dialysis machines and ventilators (also called respirators).
- “Do not resuscitate” (DNR) orders. These instruct the health care team not to use cardiopulmonary resuscitation (CPR) or carry out any intervention if your breathing or heartbeat stops.
- Receiving foods and fluids via a tube.
- Organ and tissue donation
- Comfort care/pain relief
Can Advance Directive Be Changed?
Even after advance directives have been signed, they can be changed at any time. The process of discussing advance directives should be ongoing, rather than taking place just once. In this way, one can review the documents from time to time and modify them if situations or wishes change.
To update the document, one should talk to his or her doctor and loved ones about the new decisions. When a new advance directive has been signed, the old ones should be destroyed.
Faith-based Organisations And Advance Directives
Jehovah’s Witnesses are the best example of how religious beliefs can play a massive role in making health care decisions. Members typically include strict health care limitations in their advance directives, which makes their treatment more demanding.
They usually reject treatment even if their medical practitioners believe it would save their lives.
To make this decision clear to the medical staff that may treat them at some point, members of this community usually:
- Carry a so-called “blood refusal card”
- Prepare modified advance directive forms
Conclusion
The durable medical power of attorney is an essential element in your estate planning tool kit. By utilizing a medical power of attorney, you’ll gain the peace of mind that comes with knowing someone you trust will be able to step in and make vital healthcare decisions for you if you can’t make those decisions yourself.