What Is an Advanced Care Directive?

Planning certain aspects of your healthcare may not seem like something that’s worth doing at the moment, especially because most people only think of old age when they think about an advanced care directive. But the truth is that a medical crisis could leave you without the ability to make your own healthcare decisions. The bitter reality is that a medical crisis does not discriminate based on age.

Having an advanced care directive in place can make all the difference. According to the Law Offices of Darrell C. Harriman, an “advanced health care directive outlines a person’s future wishes for his/her health care should he/she become incapacitated and unable to communicate these wishes.” Outlined by the U.S. Department of Health & Human Services (HHS), an advanced care directive can be helpful in a handful of situations. For instance, a disease could render you unable to make decisions about your healthcare. Or a severe and unexpected injury could leave you incapacitated. With neither scenario restricted to a certain age, an advanced care directive could help others know what type of medical care you need and/or want.

And even if it is not related to a disease or accident and is actually just due to old age, an advanced care directive can help express your values and wants when it comes to end-of-life care. Oftentimes, older people end up living with a chronic illness that requires day-to-day care for weeks or even months before passing away. In these occasions, you might not be able to vocalize your wishes when it comes to your end-of-life care. Outlining your desire for hospice or palliative care or foregoing any type of care through an advanced health care directive, can make your desires clear for your loved ones and your healthcare providers.

In emergency situations, an advanced health care directive can dictate what doctors can and cannot do in order to keep you alive. These decisions can relate to use of CPR, tube-feeding, IV, ventilator use, comfort care, and/or fluids. Again, others’ knowledge of your advanced health care directive can make all the difference, emergency or not.

A prime example of the anguish, suffering, financial burden and headache that a lack of an advanced care directive can have on others is the story of Terri Schiavo. According to a New York Daily Times article, Schiavo suffered severe brain damage when a medical emergency caused her to pass out at the young age of 26. She was put on a ventilator to keep her breathing and ended up in a coma for more than two months. When she came out of the coma, she was unable to speak. Doctors diagnosed her as being in a persistent vegetative state.

A problem arose years later when Schiavo’s husband moved to obtain a do not resuscitate order (DNR). Schiavo’s family did not approve and fought back in court against the DNR. The case quickly gained national attention as many argued over who had control over Schiavo’s medical care. The case ended up lasting 15 years. It included legal maneuvering, procedural delays, five federal lawsuits, 14 appeals and even involvement from Congress, Jeb Bush, and George W. Bush, who was president at the time.

Something as simple as an advanced care directive would have saved so much time, energy, money, and pain and suffering. So what does it take to create an advanced care directive?

An advanced care directive has two main elements. They are a living will and a durable power of attorney for health care. In addition, there are other documents you can use to supplement your advanced care directive.

The best part is that you can always adjust your advanced care directive throughout your life. Your health is certainly different at age 23 than at age 67. You might have developed certain health issues that you did not need to account for earlier in life. Being able to tweak your advanced care directive makes it easy to account for such changes.

A living will is a document that outlines to doctors or other medical professionals how you would like to treated or cared for if you are incapacitated or dying and are unable to make your own decision about emergency treatment. You can outline what you would want and don’t want, and the conditions under which your desires apply.

A durable power of attorney for health care is just a fancy name for a document that names someone you choose to make medical decisions for you at times when you are unable to do so. This person can be known as your proxy, representative, agent or surrogate. When it comes to picking someone to be your durable power of attorney for health care, you should select someone you trust. This person should also be aware of your personal values and beliefs. It would help if they have similar values and beliefs so as to avoid conflict if they do not support what you ask them to do. It also helps if they live in your area or near you in case they are needed for your treatment decisions over an extended period of time.

In the state of California, for example, there are restrictions on who you can choose to be your durable power of attorney for health care. It cannot be your supervising health care provider, the operator of a community or residential care facility that you are receiving assistance from. Furthermore, it cannot fall under the care of an employe in a residential, community, or health care facility where you are receiving care, unless the person you choose is your spouse, relative, or co-worker. It is also advisable to choose a backup or alternate durable power of attorney for health care. This can come in handy if your first choice is unable or unwilling to make difficult healthcare decisions for you.

Other documents that can be drafted to supplement your advanced care directive may outline your desires about a single medical issue or something not already covered. You can provide your durable power of attorney for health care with specific instructions about things like blood transfusions or kidney dialysis – treatments that might be needed in the future.

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