Advance Health Care Directives
With the increasing ability of medical science to sustain our lives, people are living much longer than ever before. Unfortunately, as we grow older and experience poor health, we may find ourselves in a position where decisions need to be made as to how we wish to be treated in a variety of medical situations at the end of our lives. Further, sometimes we find ourselves in a condition where we can no longer express our preferences. Advance health care directives allow us to deal with these situations. Without such directives, your family may find it necessary to obtain court orders to deal with your medical situation. State laws vary concerning the appropriate documents to cover these situations. All fifty states permit you to express your wishes as to medical treatment in terminal illness or injury situations, and to appoint someone to speak for you in the event you cannot speak for yourself. Depending on the state, these documents are known as "living wills," "health care proxies," or "advance health care directives." Some states have a standardized document for this process, while other states leave the language up to individual lawyers and their clients.
What if an illness or an accident leaves you in a coma? Would you want to have your life prolonged by any means necessary, or would you want to have some treatments withheld to allow a natural death? What if you are dying from a painful terminal illness? Would you want to receive medical procedures to prolong your life?
An advance directive allows you to give instructions to your health care providers and your family on these topics. You can give them instructions about the types of treatments you want or don't want to receive if you become incapacitated. Usually, directives will only go into effect in the event that you can't make and communicate your own health care decisions. Up until then, you can continue to give directions to your health care provider even though you have an advance directive.
Hospitals and other health care providers are required under the federal Patient Self Determination Act to give patients information about their rights to make their own health care decisions. That includes the right to accept or refuse medical treatment. If you have executed a Living Will, Health Care Power of Attorney, or Advance Health Care Directive, your health care provider may ask you for a copy.
Types of Advance Directives A living will is your written expression of how you want to be treated in certain medical conditions. Depending on state law, this document may permit you to express whether or not you wish to be given life-sustaining treatments in the event you are terminally ill or injured, to decide in advance whether you wish to be provided food and water via intravenous devices ("tube feeding"), and to give other medical directions that impact the end of life. "Life-sustaining treatment" means the use of available medical machinery and techniques, such as heart-lung machines, ventilators, and other medical equipment and techniques that will sustain and possibly extend your life, but which will not by themselves cure your condition. In addition to terminal illness or injury situations, most states permit you to express your
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preferences as to treatment using life-sustaining equipment and/or tube feeding for medical conditions that leave you permanently unconscious and without detectable brain activity.
A living will applies in situations where the decision to use such treatments may prolong your life for a limited period of time and not obtaining such treatment would result in your death. It does not mean that medical professionals would deny you pain medications and other treatments that would relieve pain or otherwise make you more comfortable. Living wills do not determine your medical treatment in situations that do not affect your continued life, such as routine medical treatment and non lifethreatening medical conditions. In all states the determination as to whether or not you are in such a medical condition is determined by medical professionals, usually your attending physician and at least one other medical doctor who has examined you and/or reviewed your medical situation. Most states permit you to include other medical directions that you wish your physicians to be aware of regarding the types of treatment you do or do not wish to receive.
The term advance directive can describe a variety of documents. Living Will and Health Care Power of Attorney documents are types of advance directives. Some states also have a document specifically called an Advance Health Care Directive. So, the term advance directive may be used to refer to any of these specific documents or all of them in general.
States differ widely on what types of advance directives they officially recognize. Some states also require that you use a specific form for the format and content of your advance directive. If you have specific questions, contact an attorney who is familiar with your state statutes regarding advance directives. Regardless of the name your state gives to these documents, their purpose is to allow you to express your preferences concerning medical treatment at the end of your life. By expressing such preferences in a written legal document, you are ensuring that your preferences are made known. Physicians prefer these documents because they provide a written expression from you as to your medical care and designate for the physician the person he or she should consult concerning unanswered medical questions. Rather than the physician having to obtain a consensus answer from your family as to your treatment, the physician knows your preferences and knows who you want to provide decisions when you cannot do so.
These documents provide your expressed wishes, rather than making the family guess your desires. Making your wishes known in advance prevents family members from making such choices at what is likely one of the most stressful times in their lives. Further, providing such information and designating a health care proxy means that the physician knows whose direction is to be followed in the event your family disagrees as to what medical treatment you would want. Living Will A Living Will allows you to state whether you want your life prolonged if you will soon die from a terminal illness or if you're permanently unconscious. In general, a Living Will indicates whether you want certain treatments withheld or withdrawn if they are only prolonging the dying process or if there is
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no hope of recovery.
As a general rule, Living Wills only go into effect if you're no longer able to make your own health care decisions. For example, if you suffer serious brain damage in a car accident or suffer an incapacitating stroke, you may be permanently unconscious and unable to communicate with your doctor. In this case, a Living Will lets your physician know your wishes concerning certain medical procedures.
Health Care Power of Attorney//Proxy A Health Care Power of Attorney (HCPOA) allows you to name someone (an Agent) to make health care decisions for you if you are unable to do so. The HCPOA is more flexible than a Living Will and can cover any health care decision, even if you are not terminally ill or permanently unconscious. A HCPOA can apply in cases of temporary unconsciousness or in case of diseases like Alzheimer's that affect decision making. Like a Living Will, HCPOA's often allow you to state your wishes about certain medical procedures. Also as with the Living Will, a HCPOA generally only goes into effect when you are no longer able to make your own health care decisions. A "health care proxy," sometimes called a "health care surrogate" or "durable medical power of attorney," is the appointment of a person to whom you grant authority to make medical decisions in the event you are unable to express your preferences. Most commonly, this situation occurs either because you are unconscious or because your mental state is such that you do not have the legal capacity to make your own decisions. Normally, a single individual is appointed as your health care proxy, though quite commonly one or more alternate persons are designated in the event your first choice proxy is unavailable. As with the living will, medical professionals will make the initial determination as to whether or not you have the capacity to make your own medical treatment decisions. The health care proxy is a durable power of attorney specifically designed to cover medical treatment. As with living wills, depending on your state of residence, it may be a state-determined form or may be drafted individually by your attorney. Advance Health Care Directive An Advance Health Care Directive combines the features of a Living Will and a Health Care Power of Attorney along with some other options. Some states have a specific advance directive form.
Choosing an Agent Choosing an Agent for your Advance Directive could be one of the most important decisions you ever make. Unless you state otherwise in your directive, your Agent generally has the same authority to make decisions about your health care as you would. Since this person will be acting on your behalf if you become unconscious or unable to make health care decisions, this should obviously be someone you know and trust thoroughly. Your Agent should also know you very well--well enough to be able to make the same kinds of decisions you would. And he or she should be someone who cares deeply about your welfare. People often choose their spouse or other close family member to be their Agent.
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You can limit your Agent's authority if you choose to do so. For example, you could specify that your Agent will not have authority to override your desire not to be put on life support equipment. You should make sure the person you choose is willing to be your Agent. Discuss your wishes and values with him or her in advance so he or she can make the right decisions for you. Your Agent should be an adult and cannot be your health care provider (unless that person is a family member). It is also a good idea to designate an alternate Agent in case your Agent is not able to act as your Agent for any reason.
Finalizing the Directive Once you've completed an advance directive, there are a few final steps you should take to make it effective: * Discuss your advance directive with your doctor before you sign it. Make sure you are both comfortable with what it says. He or she may suggest something you hadn't thought of that you might decide to include. * Comply with your state's signature and witness requirements. States have various requirements about who can be a witness, how many witnesses are needed, and if the directive must be notarized. * Provide copies of the signed directive to: 1) your doctor and hospital; 2) your Agent if one is named; 3) family members, and; 4) other significant people in your life.
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Advance Health Care Directive
(California Probate Code Section 4701)
1. HEALTH CARE AGENT Health Care Advance Directive Part I Appointment of Health Care Agent
I, ___________________________________________________________________ hereby
(PRINCIPAL)
appoint: ______________________________________________________________________________
(HEALTH CARE AGENT FULL NAME)
______________________________________________________________________________
(AGENT ADDRESS) (HOME PHONE#) (CITY) (STATE) (ZIP CODE)
______________________________________________________________________________
(WORK PHONE#)
as my agent to make health and personal care decisions for me as authorized in this document.
2. ALTERNATE HEALTH CARE AGENT
RE AGENT IF I revoke my Agent's authority; or my Agent becomes unwilling or unavailable to act; or if my agent is my spouse and I become legally separated or divorced,
I name the following (each to act alone and successively, in the order named) as alternates to my Agent: A. First Alternate Agent Name_______________________________________________________________________ Address_____________________________________________________________________
(City) (State) (Zip Code)
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Telephone____________________________________________________________________
B. Second Alternate Agent Name_______________________________________________________________________ Address_____________________________________________________________________
(City) (State) (Zip Code)
Telephone____________________________________________________________________
3. EFFECTIVE DATE & DURABILITY E F
By this document I intend to create a health care advance directive. It is effective upon, and only during, any period in which I cannot make or communicate a choice regarding a particular health care decision. My agent, attending physician and any other necessary experts should determine that I am unable to make choices about health care.
4. AGENTS POWER / AUTHORITY E F
I give my Agent full authority to make health care decisions for me. My Agent shall follow my wishes as known to my Agent either through this document or through other means. When my agent interprets my wishes, I intend my Agent's authority to be as broad as possible, except for any limitations I state in this form. In making any decision, my Agent shall try to discuss the proposed decision with me to determine my desires if I am able to communicate in any way. If my Agent cannot determine the choice I would want, then my Agent shall make a choice for me based upon what my Agent believes to be in my best interests. Unless specifically limited by Section 6, below, my Agent is authorized as follows: (a) To consent, refuse, or withdraw consent to any and all types of health care. Health care means any care, treatment, service or procedure to maintain, diagnose or otherwise affect an individual's physical or mental condition. It includes, but is not limited to, artificial respiration, nutritional support and hydration, medication and cardiopulmonary resuscitation;
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(b) To have access to medical records and information to the same extent that I am entitled, including the right to disclose the contents to others as appropriate for my health care; (c) To authorize my admission to or discharge (even against medical advice) from any hospital, nursing home, residential care, assisted living or similar facility or service; (d) To contract on my behalf for any health care related service or facility on my behalf, without my Agent incurring personal financial liability for such contracts; (e) To hire and fire medical, social service, and other support personnel responsible for my care; (f) To authorize, or refuse to authorize, any medication or procedure intended to relieve pain, even though such use may lead to physical damage, addiction, or hasten the moment of (but not intentionally cause) my death; (g) To make anatomical gifts of part or all of my body for medical purposes, authorize an autopsy, and direct the disposition of my remains, to the extent permitted by law; (h) To take any other action necessary to do what I authorize here, including (but not limited to) granting any waiver or release from liability required by any hospital, physician, or other health care provider; signing any documents relating to refusals of treatment or the leaving of a facility against medical advice; and pursuing any legal action in my name at the expense of my estate to force compliance with my wishes as determined by my Agent, or to seek actual or punitive damages for the failure to comply.
Health Care Advance Directive Part II Instructions About Health Care 5. MY INSTRUCTIONS ABOUT END-OF-LIFE TREATMENT
(Initial only ONE of the following statements)
_______ NO SPECIFIC INSTRUCTIONS. My agent knows my values and wishes, so I do not wish to include any specific instructions here. DIRECTIVE TO WITHHOLD OR WITHDRAW TREATMENT. Although I greatly value life, I also believe that at some point, life has such diminished value that medical treatment should be stopped, and I should be allowed to die. Therefore, I do not want to receive treatment, including nutrition and hydration, when the treatment will not give me a meaningful quality of life. I do not want my life prolonged...
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_______... if the treatment will leave me in a condition of permanent unconsciousness, such as with an irreversible coma or a persistent vegetative state. _______ ... if the treatment will leave me with no more than some consciousness and in an irreversible condition of complete, or nearly complete, loss of ability to think or communicate with others. _______ ... if the treatment will leave me with no more than some ability to think or communicate with others, and the likely risks and burdens of treatment outweigh the expected benefits. Risks, burdens and benefits include consideration of length of life, quality of life, financial costs, and my personal dignity and privacy. _______ …DIRECTIVE TO RECEIVE TREATMENT. I want my life to be prolonged as long as possible, no matter what my quality of life. _______... DIRECTIVE ABOUT END-OF-LIFE TREATMENT IN MY OWN WORDS: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
Check or Mark the Box if Additional Space is needed. Number of Pages Attached _____. (If the box is checked Label your Attached Paper “End of Life Treatment Directives Attachment”)
6. ANY OTHER HEALTH CARE INSTRUCTIONS OR LIMITATIONS OR MODIFICATIONS OF MY AGENTS POWERS
______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ANY OTHER HEALTH CARE INSTRUCTIONS OR
Check or Mark the Box if Additional Space is needed. Number of Pages Attached _____.
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(If the box is checked Label your Attached Paper “Other Health Care Instructions Attachment”)
7. PROTECTION OF THIRD PARTIES WHO RELY ON MY AGENT
TS No person who relies in good faith upon any representations by my Agent or Alternate Agent(s) shall be liable to me, my estate, my heirs or assigns, for recognizing the Agent's authority.
8. DONATIONS OF ORAGAN & TISSUES DON
Upon my death: (Initial one) _____ I do not wish to donate any organs or tissue, OR _____ I give any needed organs, tissues, or parts, OR _____ I give only the following organs, tissues, or parts: (please specify) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
My gift (if any) is for the following purposes:
(Cross out any of the following you do not want)
Transplant Research Therapy Education
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9. NOMINATION OF GUARDIAN If a guardian of my person should for any reason need to be appointed, I nominate my Agent (or his or her alternate then authorized to act), named above.
10. ADMINISTRATIVE PROVISIONS AD (All apply) I revoke any prior health care advance directive. This health care advance directive is intended to be valid in any jurisdiction in which it is presented. A copy of this advance directive is intended to have the same effect as the original. M
SIGNATURE & WITNESS DECLARTION(S)
BY SIGNING HERE I INDICATE THAT I UNDERSTAND THE CONTENTS OF THIS DOCUMENT AND THE EFFECT OF THIS GRANT OF POWERS TO MY AGENT.
I sign my name to this Health Care Advance Directive on this _____ day of___________________________ , 19____. _____________________________________________________________________
(PRINCIPAL SIGNATURE)
_____________________________________________________________________
(PRINT PRINCIPAL FULL NAME)
_____________________________________________________________________
(ADDRESS) (CITY) (STATE) (ZIP CODE)
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WITNESS STATEMENT I declare that the person who signed or acknowledged this document is personally known to me, that he/she signed or acknowledged this health care advance directive in my presence, and that he/she appears to be of sound mind and under no duress, fraud, or undue influence. I am not: the person appointed as agent by this document, the principal's health care provider, an employee of the principal's health care provider, financially responsible for the principal's health care, related to the principal by blood, marriage, or adoption, and, to the best of my knowledge, a creditor of the principal/or entitled to any part of his/her estate under a will now existing or by operation of law.
Witness #1:
___________________________________________ (Signature) (Date) ___________________________________________ (Print Name) ___________________________________________ (Telephone) ___________________________________________ (Address)
Witness #2:
_____________________________________________ (Signature) (Date) _____________________________________________ (Print Name) _____________________________________________ (Telephone) _____________________________________________ (Address)
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NOTARIZATION
| ) |State of California ) |County of __________ ) | ) | ) |________________________/
On __________________________ before me, (here insert name and title of the officer), personally appeared ______________________________ ,who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. OR STAMP NOTARY SEAL
_______________________________ [Notary Signature]
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Blank Attachment Paper