Dr. Cheryl Woodson

Woodsonian Thoughts on Thursday: Advance Directives – Not About Dying, but Describing How You Want to LIVE

Advance directives direct your doctors, other health care providers, and your family about your wishes in advance, before a serious illness steals your ability to speak for yourself. These documents are not about dying. These documents describe the how you want to live, and they are not just for the aged. Listen parents: once your state recognizes your child as an adult, you are no longer the guardian. The law does not allow doctors to share medical information without written permission, even if your child is incapacitated. Some doctors will, but they don’t have to. Hand your child one of these forms with that special “legal age” birthday card. In Illinois, that age is eighteen.

• The Living Will describes your wishes when you have a terminal illness. It’s like saying, “If I am dying and can’t communicate, do this, but not that.” Unfortunately, living wills don’t apply if you’re not dying, or if something happens that you didn’t consider.

Power of Attorney for Health Care (POA) applies regardless of the reason, or length of time doctors expect that you won’t be able to communicate. It gives permission for a person (advocate) to act as you would, if you could. The forms have space for basic instructions to your advocate, but it is critical that you TALK to the person, so she understands the kind of life you would consider worth living. For example, my husband knows I could tolerate difficulty speaking and losing the use of my legs, but I would not want to live totally paralyzed, or without my memory and intelligence. Make decisions about what “quality of life” means to you and choose someone you trust to decide according to your wishes, not theirs.

Fearing law suits, first responders and other health care providers can choose to ignore these documents, so professionals in Oregon developed…

Physician Orders for Life-Sustaining Treatment (POLST,) a signed physician order that other professionals must respect. POLST not only lists treatments that you would and would not want; it also allows you to consider the amount of time you would want to use a treatment. It’s also designed to make advance directives discussions easier for doctors and families.
The document you need depends on how much you travel. The laws in some states and countries may differ your home state, and while most have enacted POLST legislation, it is not yet nationwide. A local attorney, or bar association should be able to advise you about the laws in locations you visit, but you do not need an attorney to prepare an advance directive.
Doctors’ offices, hospitals, nursing facilities, home health agencies, hospice and palliative care programs should have forms; you can also download, or complete them online. By law, health facilities must ask if you have an advance directive, but often, that question leads to checking a box, not an in-depth conversation. Talk to your doctor; invite a health care professional, or attorney to address your church, or community group.

As long as you can use any form of communication to show that you understand your condition, the options, and consequences (informed consent,) ADVANCE DIRECTIVES DO NOT APPLY. Doctors must establish that you are unable to advocate for yourself. The person you designate cannot just take over because she doesn’t like your decisions. Since your representative follows your instructions, advance directives do not make you more vulnerable; they make sure that you are always in control, even when you can’t communicate.

NEXT WEEK: Preparing the documents, family discussions, and understanding DNR orders.

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