With Terri Schiavo at the center of a national ethical debate, people are assessing what, if any, kind of life-sustaining support they would want in similar circumstances. Since 1990, the Supreme Court has maintained that a competent person always has the constitutional right to accept or refuse medical treatment. However, when you are unable to speak for yourself, who do you want to speak for you? And what kind of limitations do you want to place on their authority? Here are five important things you need to keep in mind about advance health care directives:
Know What Documents Do What. By executing a Health Care Power of Attorney, you appoint someone to make health care decisions for you if you are physically or mentally incompetent. A Living Will, on the other hand, is a directive from you to your doctors letting them know whether you would like to receive artificially supplied life-sustaining treatment. Since these documents originate at the state level, there are inevitably statutory variations among states that can affect how and even if your wishes are implemented. In Ohio, there are separate documents for a Health Care Power of Attorney and a Living Will. In Kentucky, however, there is a single document called “Living Will Directive and Health Care Surrogate Designation.” While you appoint someone to make decisions for you, that person may or may not be authorized to make medical treatment directions or authorizations about food and water.
Choose Your Health Care Decision Makers Carefully. Before executing any health care document, discuss your wishes with your designee to ensure that they understand your wishes and that they have no ethical objections to your decision. You will want to ensure that your designee will act as you have directed and not according to their own ethical opinions.
Give Copies of Any Documents to Your Primary Care Physician. Always give a copy of your documents to your primary care physician to be placed in your permanent medical record. Not only does this ensure the availability of the document, but also it allows you to discuss the practical consequences of the documents with your doctor so you can make a full and informed decision.
Update it Frequently. Like all legal documents, you should ensure that they are kept up to speed with the circumstances of your life. The older a document is, the more likely it is to be challenged as not reflective of your current wishes. A recent document, on the other hand, can be clear and convincing evidence of your wishes. I recommend that everyone execute their desired advance health care directives every few years.
Cross Your T’s and Dot Your I’s. Although most states have developed forms for their health care directives, you should always consult with an attorney to make sure the document complies with wishes. If you have any specific religious beliefs on blood transfusions, organ transplants, or other medical treatments, you should consult with a clergyman and make your beliefs evident in your documents. Also, be wary of forms given to you at the hospital as some hospitals have modified the forms prescribed by statute. You should also remember that if a hospital refuses to honor your advance health directive, you are allowed to be transported to another facility where your wishes will be respected.