Terri Schiavo's family probably never imagined the decisions they would have to make regarding her care. But the court battle surrounding this 41-year-old woman, who was in a vegetative state since a 1990 heart attack, has reminded us all about the importance of clearly informing your family of your wishes regarding end-of-life medical care.
The U.S. government has granted citizens the right to have certain documents, called advanced directives, which allow mentally competent people to outline their health-care decisions for a time in the future when they are unable to speak on their own behalf. These provisions give you control over the type and degree of treatment you desire should your life be in jeopardy.
Advanced directives are a difficult subject to even think about, let alone broach with family, but it is an important conversation to have in order to ensure that you live—and die—according to your own desires.
All about Advanced Directives
An advanced directive is any legal document that allows a patient to express his or her wishes concerning health care. There are three major forms of advanced directives: a living will, durable power of attorney (DPA) for health care and a do not resuscitate order (DNR). Be advised that different states have different laws regarding advanced directives, so be sure to find out about the laws in your particular area.
In general, anyone 18 or older can obtain an advanced directive. Again, different states have different laws pertaining to the number and types of witnesses needed for such a document. But in all cases, it is important to discuss your end-of-life health care desires with your family, so that they clearly understand your wishes if a major medical decision has to be made.
Living Wills
A living will is an advanced directive that is only used should you become terminally ill. Two doctors must agree that a patient is either in an irreversible coma or has less than six months to live and is unable to make medical decisions.
In a living will, a person can describe the types of treatment that should be administered or withheld in certain situations. This document is legally binding and cannot be overturned by anyone, including doctors or family members, other than the patient. The patients themselves can revoke this document at any time by telling a witness, tearing it up or putting their new decision in writing.
Health
Durable Powers of Attorney (DPA)
If you wish to name someone else to speak on your behalf when you are not able to do so, you can obtain a DPA, also called a health care proxy. In this document, you can name any adult (over 18) to be your surrogate decision maker. This person will then be legally allowed to make medical decisions about your treatment if you become incapacitated. Unlike a living will, a DPA can be used at any point that you are unable to make your own health care decisions, not only in the case of a terminal illness or coma.
A DPA can outline the types of treatments that you permit your proxy to make decisions about and can even describe your treatment wishes in various medical scenarios. Like a living will, a DPA can also be revoked at any time by informing a witness, tearing it up or putting it in writing.
For a DPA to take effect, two doctors need to agree independently that you are unable to make health care decisions. The person named in the document, however, does have the right to refuse the responsibility. To prepare for this possibility, other people can be named in the DPA as successors.
Do Not Resuscitate Orders (DNR)
DNR orders are the most universally accepted form of advanced directive. They inform doctors and hospitals not to use cardiopulmonary resuscitation (CPR) if your heart stops beating or if you stop breathing. A DNR request can be made at any time, as long as you are deemed fit to make medical decisions. Or, in the case of a DPA, it can be made by your representative. Your doctor will write the request prominently in your medical chart so all members of the hospital will be aware of it.
Inform Your Family
Generally, a hospital will ask the patient or family about any advanced directive upon admission. Doctors and named health-care proxies should be given copies of these forms for their records. Some people choose to also give copies to their families, but, even if you don't, it is important that you inform your family of the existence of an advanced directive and take the time to discuss your decisions with them. No family member, other than one named by a DPA, can override an advanced directive.
Even if your state does not have laws permitting the use of a living will, one can be written to help direct your family regarding health care decisions.
State-specific advanced directives can be requested and more information about these documents can be found at the National Hospice and Palliative Care Organization's website at www.nhpco.org.
