Advance Medical Directives
A medical directive can be a living will or a durable power of attorney for health care (also called a health care proxy). These documents allow you to give directions about your future medical care.
Having an advance directive is good for everyone young or old, since accidents and illness can strike at any time. It’s your right to accept or refuse medical care. Advance directives can protect this right if you become mentally or physically unable to choose or tell someone your wishes.
Before making an advance directive, think about what’s important to you. How would keeping or losing the ability to do things you value affect your choice of treatment? Find out about all the treatments open to you. Then you can decide the level of care that you would want. Advance directives can help you protect your right to make medical choices, help your family avoid the stress of making hard decisions and help your doctor by giving him guidelines for your care.
Once you know what level of medical care you want, you can protect your wishes by putting them in writing. With an advanced directive, you can name someone else to make medical choices for you (durable power of attorney for health care) or you can state the treatments you’d choose or not choose (living will).
There are two types of advanced medical directives that you may want to consider completing and keeping with your files while you are here at UAMS. For example, you can name someone to make decisions about your care in a form known as a Health Care Proxy. You can chose whether this person makes decisions about your personal care, medical care, hospitalization and if there are any limitations on who may visit you.
In Arkansas, the person you name on this form only has authority if you become permanently unconscious or if you are unable to speak for yourself and have a terminal condition.
Advance directives can limit life-prolonging measures when there is little or no chance of recovery. You may decide not to be put in the hospital if you are terminally ill or permanently unconscious. You may decide against any treatments that will not cure you.
Advance directives can help you make known your feelings about:
- Cardiopulmonary resuscitation (CPR) – When the heart stops (cardiac arrest), doctors and nurses use special measures to try to restart the heart. This may include massaging the heart, giving medicine or using electrical shock.
- Intravenous (IV) therapy – Can be used to provide food, water and/or medicine through a tube placed in the vein.
- Feeding tubes – If you are no longer able to swallow food, your doctor may have you tube fed through your nose, your abdomen or intravenously (through the vein).
- Ventilators (artificial breathing) – Ventilators are machines that breathe for you. In your Living Will, you can make it clear whether you want this kind of help or not.
The second form is called a living will, which explains your wishes in writing about your health care if you have a terminal condition. These documents are called “living” wills because they take effect while a patient is still alive. This form lets you determine whether you receive antibiotics, surgery, blood products, breathing treatments, food or other medical treatments if you are terminally ill or permanently unconscious.
Adult patients of sound mind have the right to accept or refuse any medical or surgical treatment. This includes the right to accept or refuse treatment through a Living Will.
A Living Will is a document in which you tell others of your wish to be allowed to die a natural death if you should become unable to express your wishes in the future. The Living Will tells medical professionals and members of your family to what extent special means should or should not be used to keep your body alive if you are incurably ill. The Living Will allows you to refuse certain medical procedures that may only prolong dying, or maintain the body in an unconscious state. The Living Will is to be used only if you become terminally ill or permanently unconscious.
It is not necessary that you be seriously ill or anticipating illness to benefit from having a Living Will. In fact, a Living Will can help protect your family members from unnecessary emotional stress resulting from having to make important decisions in an unexpected crisis. A Living Will enables you to control the extent to which extraordinary measures will be used to prolong your life, and it relieves others from the responsibility of having to make such decisions.
Your Living Will affects only those types of treatment which, in the opinion of your doctor, would only serve to postpone the moment of death by artificially altering your body’s vital functions. Some examples include:
- Artificial Feeding: If a patient is no longer able to swallow food, nourishment may be supplied through tubes inserted in the nose or an incision in the abdomen.
- Artificial Ventilation: Machines which assist or control your breathing are called ventilators. Some patients are totally dependent on ventilators and would die without their support. A Living Will can address the question of continuing such support when there is no prospect of improvement.
- Cardiopulmonary Resuscitation (CPR): When the heart stops (cardiac arrest), special measures called cardiac resuscitation may be used to try to restart the heart. CPR includes the use of heart massage, intravenous medications and electrical shock. Your Living Will may direct that any or all of these not be used.
A Living Will affects only measures which are deemed to be useless. Making a Living Will does not mean that you will be abandoned. Doctors and nurses will continue attending to your needs, and every effort will be made to keep you comfortable. Humane treatment will continue.
If you would like a copy of either of these forms, ask your nurse. After reviewing them, you may sign them and ask that they be placed in your medical records.
Durable Power of Attorney
In writing, you can name a person (called a proxy) to make decisions for you if you become unconscious or mentally unable to decide.
How Do I Create Advance Directives?
Check the laws in your state regarding living wills and durable power of attorney documents for health care. Put your wishes in writing, and be as specific as you can be. You can build an advanced directive. Sign and date your advance directive. You must have two adults, other than your health care worker, witness and sign the form before it is legal.
What do I do with my living will and health care power of attorney?
Keep a card in your wallet stating that you have advance directives and where to find them. Give your doctor a copy to be kept as part of your medical records. If you use a durable power of attorney for health care, be sure to give a copy to the person who will be making decisions for you. Talk about your advanced directives with your family and friends. Give copies to a relative or friend who might be called in an emergency.
Review your advanced directives regularly and make changes as needed. Tell your doctor, family and friends about any changes you make.
Questions and Answers About Advance Directives
Who is qualified to make an advance directive?
- A patient who can make decisions and understand the impact of that decision on treatment
- An adult age 18 or older
- An emancipated minor
An advance directive will be honored if:
- The patient is 18 years of age or older
- The patient has declared his wishes or appointed a health care proxy
- A doctor has diagnosed a terminal condition or a permanently unconscious state
What if I change my mind?
You can change or cancel your advance directive at any time. Make sure you tell your doctors, health care workers, hospital and friends that your wishes have changed. Ask them to tear up and destroy old copies.
What can be done if my wishes are not being carried out?
You should talk with your doctor first. If it is not resolved at this point, talk with the nurse, social workers and/or chaplain.
Your living will and health care power of attorney involve some of life’s most important choices. Don’t put off asking for help. Talk to your doctor about any questions or ask him to refer you to someone who is qualified to help.