Future Planning 4 – Advance Directives

There are a variety of names given to the documents in this area, perhaps the most common being a “living will”. But regardless of the name the purpose of these documents is to capture your preferences in regards to what medical treatment you do or do not desire to have.

While these preferences are usually indicated through a conversation with your physician who may give you the available options, during end-of-life situations you may not be conscious or may have a condition such as dementia that prevents you from giving your consent. Thus, you need to have some sort of means of indicating your preferences.

The regulations for these may vary by state, so you will need to do some checking on what documents are legally accepted in your state. In Pennsylvania, where I live, there is a standard state form with the innocuous title of “Declaration” that you can use to indicate your preferences. It covers such things as do or do you not want to have tube feeding; do or do you not want cardiac resuscitation; do or do you not want transfusions; etc.

It also includes the following two statements:

·         I realize that if I do not specifically indicate my preferences regarding any of the forms of treatment listed above, I may receive that form of treatment.

·         I designate _____ as my surrogate to make medical treatment decisions for me if I should become incompetent and in a terminal condition or in a state of permanent unconsciousness.

However, medical professionals I have talked to have indicated that these two rather short statements are probably not sufficient. Thus, in addition to these statements of preference on the “Declaration,” it is good to have another document which is titled “Designation of Patient Advocate for Health Care” which expands on these brief statements. The two bulleted items above are instead stated as:

·         In making decisions for me, my patient advocate shall be guided by my wishes, whether expressed orally, in a living will, or in this designation.  If my wishes as to a particular situation have not been expressed, my patient advocate shall be guided by his or her best judgment of my probably decision, given the benefits, burdens and consequences of the decision, even if my death, or the chance of my death, is one consequence.

·         I designate _______ as my patient advocate to make care, custody, or medical treatment decisions for me only when I become unable to participate in medical treatment decisions.  The determination of when I am unable to participate in medical treatment decisions shall be made by my attending physician and another physician or licensed psychologist.

Note that this wording not only expands the advocacy role to care and custody decisions as well as medical treatment, but expands the types of options to any situations, not just the limited few in the standard Pennsylvania “Declaration.”

Like the POA discussed earlier, it is best to have as broad a definition and role for your Patient Advocate as the types of medically related decisions that may have to be made on your behalf could vary greatly.

While I had the POA for my mother-in-law, my wife was her patient advocate. One of my mother-in-law’s problems was fairly severe hearing loss. So while she was mentally competent to make decisions, she was unable to hear or understand what was being asked of her. The role that my wife filled in interpreting and assisting in making any care or medical treatment options was greatly needed.