Advance Directives – Keeping You in Control of Your Care
You may have heard the term “advance directives” and are wondering what it means. Advance directives are a set of legally binding documents that instruct your caregivers and your family how you wish your medical care to be handled should you become unable to speak for yourself. They primarily include:
Health Care Power of Attorney
Do Not Resuscitate (DNR) Orders
Anatomical Gift Designation
The Living Will: Allowing You to Determine and Designate the Care You Will Receive
A Living Will is a document that allows you, in advance, to establish the type of medical care you want to receive if you become terminally ill or permanently unconscious. A Living Will gives your physician the authority to withhold life-sustaining treatment, providing you with only that care necessary to make you comfortable and relieve your pain.
While the law allows your closest family members to challenge a physician’s determination that you are terminally ill or that you are permanently unconscious, it does not allow your family to challenge your own legally-documented decision to not be resuscitated.
Regardless of your condition, if you are able to speak and tell your physician your wishes, the Living Will is not used.
The Health Care: Power of Attorney – Designating Who Can Make Decisions for You
A Health Care Power of Attorney (sometimes referred to as a Durable Power of Attorney for Healthcare) is a document that allows you to designate a person to make health care decisions on your behalf should you become unable to make them for yourself. This person becomes your “attorney-in-fact” when it comes to medical care decisions.
It’s important to understand that a Health Care Power of Attorney is different from a financial Power of Attorney that you grant to someone to make financial decisions for you.
The person named as your Health Care Power of Attorney has the power to authorize or refuse medical treatment on your behalf. This authority is recognized in all medical situations when you are unable to express your own wishes. Unlike a Living Will, it is not limited to situations in which you are terminally ill or permanently unconscious. For instance, your physician may consult with your healthcare attorney-in-fact should you be under anesthesia for a surgical procedure or otherwise temporarily unconscious.
There are certain limitations on the decisions your designee can make on your behalf, such as a limited authority to order that life-sustaining treatment be withdrawn from you, or that comfort care be withdrawn. You can also add other special limitations. You should review these limitations with your Health Care Power of Attorney to make sure they understand and agree to uphold them.
How to Complete a Living Will and Healthcare POA
You can find the forms for completing a Living Will or Healthcare Power of Attorney from your physician or attorney. All hospitals and long-term care centers will have copies of these. Or, you can find a copy online at the Ohio Hospice and Palliative Care Organization. It is important that you complete the form for Ohio. Different states have different laws and subsequently different binding forms.
Neither document is complete until it has been dated and signed by a Notary Public or dated and signed in the presence of two witnesses who must also sign, date and include their addresses. Certain people are not permitted to serve as witnesses, including anyone related to you by blood, marriage or adoption, your attending physician, or the administrator of the nursing home where you may be living.
Once you have completed these forms and had them appropriately witnessed, it is a good idea to give copies to your personal physician, any contacts you have listed in the documents, and to the appropriate personnel within a hospital or long-term care center where you are receiving care. It is also advisable to keep a copy of it with other important medical papers that you carry with you such as a list of prescribed medications you are taking and emergency contact numbers.
Remember, your Living Will takes precedence over the Health Care Power of Attorney so be sure that the designations within both are consistent.
You can revoke your Living Will and Health Care Power of Attorney at any time.
Understanding Do Not Resuscitate Orders
Ohio law has provisions for two types of Do Not Resuscitate (DNR) orders – the DNR Comfort Care (DNRCC) and DNR Comfort Care-Arrest (DNRCC-Arrest). Unlike the Living Will and the Health Care Power of Attorney, these must be written, or prescribed, by a physician, an advanced-practice nurse or certified nurse practitioner after consultation with the patient.
Under the DNRCC protocol, a person receives any care that eases pain and suffering, but no resuscitative measures to save or sustain life.
DNRCC excludes heroic life-saving measures such as CPR, but makes provisions for keeping a person comfortable and comforted such as clearing of airway passages, administering oxygen, positioning for comfort, pain medication, emotional support, etc. With the DNRCC – Arrest – a person receives standard medical care until the time he or she experiences a cardiac or respiratory arrest.
Once you and your physician have decided on a DNR protocol, you will receive a special identification form or wallet identification card; whichever form you have, it must include the Ohio State DNR logo to be valid.
You always have the right to change your mind about your DNR status. In such cases, you should speak with your physician immediately about revoking your DNR order.
Still Have Questions?
The subject of advance directives is often difficult to approach. But it’s important to realize that by discussing these matters and making your wishes known, you are exercising ultimate control over your life; and in addition, you are giving your loved ones a sense of peace by letting them know, without doubt, what your wishes are.
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Advance Directives – Keeping You in Control of Your Care