Health Care Directive.
“I don’t want to be hooked up to tubes and machines.” This is one of the most common wishes for people who are trying to vocalize their end of life wishes. However, tubes and machines don’t always mean it’s the end of the patient’s life. While creating a health care directive, you need to be specific — medically specific — so as not to leave vague instructions that could mean unnecessary stress or legal actions.
While you should consult with an estate planner to create a comprehensive health care directive, you might also consider consulting with a physician. Health Care Directive need to be created through a series of realistic scenarios, and you need a coordinated effort between your doctor and your lawyer to make sure you wishes are reflected in your end of life instructions.
Often, people are very uncomfortable when discussing end of life health issues. In order to shorten the conversation, they will use broad, vague statements (like to one above) to avoid the painful conversation. Your lawyer can give you a set of questions that you can review with your loved ones and your doctor.
Keep in mind, tubes and machines aren’t just a way to keep you alive — they keep you alive to help you get better. Two months on a machine might mean another ten years alive.
It’s critical to review the questions and the answers with your family. They might be surprised at your decisions, but it’s better to discuss your answers now, in person. Then, your answers feed into your estate plan creating a comprehensive health care directive. The process can take several weeks and generally will involve several conversations. So, start now.Read More
When you create a healthcare directive, frequently called a DNR or Do Not Resuscitate, you will need to select up to three people who will be willing to act on your behalf. You will select one primary health care agent along with two other contingency agents. One of these people will make your medical decisions when you have lost the ability to vocalize your own wishes.
Your agent will:
Select the hospital, clinic, or nursing home where you will receive care
Select your doctors
Approve all medical treatments
Decide on post-mortem issues such as organ donation and corporal disposal
Initiate any legal action to ensure your wishes are fulfilled
The person who becomes your health care agent will carry a significant responsibility. Make sure that you ask each person before adding them to your health care plan. In addition, make sure you share the health care plan with each person; one or more may have moral or religious beliefs that are in conflict with your wishes.
Most importantly, create a thorough health care directive. The directive become the guideline by which the agent will make all the decisions. If your directive is incomplete or vague, then the agent will be left to make difficult decisions without your guidance. Work with an estate attorney to ensure that your health care directive is complete and covers all of your final wishes.Read More
As part of your Health Care Directive, you will have to decide if you want some or all of your organs donated. If you strongly believe that you want your organs donated, you should contact a lawyer to ensure this is clearly spelled out in a legal document. Do not assume that because your driver’s license says “organ donor” your organs will be donated.
Organ donation is a sensitive and difficult question for family members. Frequently, religious beliefs become part of the conversations about organ donation. If you have differing opinions about organ donation within your family, you should make the choice now and document your decision. Once you are ill or once you have passed away, it is too late to have a healthy conversation about tissue donation.
There are several choices when it comes to organ donation and the options may vary because of where you live. However, you generally choose the organs and tissues you want to donate. In addition, you can opt as to how you want your organs to be used: transplant, therapy, research, or education.
Once you have made your choices about organ donation and documented the choice with an estate planner/lawyer, discuss your directive with your family. When you are sick, there will be more important matters on which to focus.Read More
In late 2013 and early 2014, the Munoz family became part of a national debate regarding health care directives. The majority of the discussion revolved around the fate of the unborn child of a brain dead wife and mother, Marlise Munoz. While this case was an extreme and unusual case, it brought to light the need for everyone to have a professionally written health care directive.
Prior to this case, there were probably very few health care directives that included this particularly unlikely scenario. However, the content of a homemade health care directive and the content of one written by an estate attorney can be the difference between a peaceful end of life and one filled with familial conflict. Regardless of your religious views on life and death issues, creating a comprehensive end of life plan will ensure that you will not be the subject of guilt, regret, or conflict.
A good estate attorney will ask you a series of questions about various medical scenarios. (It’s likely your lawyer will now include the scenario brought to light by the Munoz family.) With the ever-advancing state of medical care, you will have more and more options as to how you would like to live if you became incapacitated. Be prepared for some difficult questions about various quality of life issues. In fact, you should request a list of those questions from your lawyer before sitting down and providing answers.
The Munoz family had been responsible in having a thorough conversation with each other about end of life issues. Now, go one step further for yourself. See an estate lawyer.
Source: Miller, Tracy. December 23, 2013. “Texas man wants pregnant wife taken off life support” New York Daily NewsRead More
Your health care directive gives you the chance to speak now about how you want to live out the end of your life if you are not able to speak for yourself.
If you’ve done any reading about health care directives, you know many articles dance around the toughest questions. Because care and treatment about the end of your life is complex, it’s best not to rely on vague articles to guide you in creating a plan. You should consult a lawyer to help you construct an effective and thorough health care directive.
When you go see your lawyer, however, you should be prepared to answer some very tough questions. Most articles about this topic give a standard example question. “Do you want to be kept on a feeding tube?”
A good health care directive does not focus on treatments such as feeding tubes and care requirements. A good health care directive is going to ask you about quality of life.
It’s best to assume that your lawyer will want you to think about some of the hardest questions. You may need two or three appointments to work through all of the details.
Here are a few of the tough questions:
- On a scale of 1-10, what level of pain are willing to live with on a daily basis?
- On a scale of 1-10, what level of discomfort (nausea, vomiting) are you willing to live with on a daily basis?
- If you are unable to clean or bathe yourself, where do you expect to live?
Lastly, don’t shy away from putting in some personal notes about the reasons behind your choices. Something like, “I saw my Uncle Wayne live with intolerable pain for six months and I am not willing to do the same.” This will help your family’s emotional state as they carry out your last wishes.Read More
You have many choices of what to put in your health care directive. For example, you may include:
The person you trust as your agent to make health care decisions for you.
You can name alternative agents in case the first agent is unavailable, or joint agents.
Your goals, values and preferences about health care.
The types of medical treatment you would want (or not want).
How you want your agent or agents to decide.
Where you want to receive care.
Instructions about artificial nutrition and hydration.
Mental health treatments that use electroshock therapy or neuroleptic medications.
Instructions if you are pregnant.
Donation of organs, tissues and eyes.
Who you would like as your guardian or conservator if there is a court action.
You may be as specific or as general as you wish. You can choose which issues or treatments to deal with in your health care directive.
There are some limits about what you can put in your health care directive. For instance:
Your agent must be at least 18 years of age.
Your agent cannot be your health care provider, unless the health care provider is a family member or you give reasons for the naming of the agent in your directive. You cannot request health care treatment that is outside of reasonable medical practice. You cannot request assisted suicide.
Your health care directive lasts until you change or cancel it. As long as the changes meet the health care directive requirements listed above, you may cancel your directive by any of the following:
A written statement saying you want to cancel it.
Telling at least two other people you want to cancel it.
Writing a new health care directive.
Your health care provider generally will follow your health care directive, or any instructions from your agent, as long as the health care follows reasonable medical practice. But, you or your agent cannot request treatment that will not help you or which the provider cannot provide.
If the provider cannot follow your agent’s directions about life-sustaining treatment, the provider must inform the agent. The provider must also document the notice in your medical record. The provider must allow the agency to arrange to transfer you to another provider who will follow the agent’s directions.Read More