Protect Your Rights as a Patient

Jeffrey Brown, M.D.

What everyone needs to know about advance medical directives

Posted June 22, 2011

By Jeffrey Brown, M.D.

You have the right to choose what kind of health care you want—to determine what happens to you if you’re sick and unable to communicate. In addition, you have the right to determine what should happen to your body parts after you leave this world. These decisions can be made by completing something called advance medical directives.

In short, advance medical directives tell your loved ones what to do. They’re legal documents that allow you to give directions for your future medical care. There are two general types of advance directives: a living will and a durable power of attorney. It is important to know that these advance directives apply only to your medical care. They do not apply to your financial affairs. Please note that the information here is general. Because laws and regulations vary from state to state and are subject to change, the information in this chapter cannot take the place of legal counsel.

Living Will

A living will explains your wishes. This document is a set of written instructions that explain your wishes for the medical treatments you do want and don’t want if you become unable to speak for yourself. It’s important to understand that a living will is limited. It only becomes effective if you are terminally ill or in an irreversible coma and are unable to communicate. A living will specifically outlines your wishes if you find yourself in this type of condition.

Durable Power of Attorney

A durable power of attorney for health care puts someone else in charge. This document lets you name a person (an "agent" or "proxy") to make your medical decisions if you’re unable to do so. This document may also be called a "health care proxy." A durable power of attorney as opposed to a living will can apply whenever you are unable to communicate your own medical decisions, due to any illness or injury. In addition, your agent or proxy who knows your concerns can respond to situations that a document cannot address.

You Need Both

Every adult should prepare advance directives—both a living will and a durable power of attorney for health care. Basically, advance directives help protect your rights in the event that you’re unable to state your wishes. They give specific directions for your medical care by letting the medical staff know what medical procedures you would or would not want.

Tragically, an accident or illness can take away a person’s ability to make health care decisions. The trouble is that decisions still have to be made. If you cannot make those decisions, someone else will. As unfortunate as the Terri Schiavo case was, it taught us all a valuable lesson. In this case, the federal government intervened in a private medical matter because there were no clear directives. What became clear was the necessity of completing advanced directives—even if you are young.

Please consider taking steps to control these decisions now, so that they will reflect your own wishes in the future. Do so by preparing both a living will and a durable power of attorney for health care.It is important to note that you will still receive high quality care, even if you refuse life-prolonging measures within your advance directives. Even if you decide to refuse measures that will prolong your life (contained in ado not resuscitate order), the healthcare staff will do everything they canto get you well, except resorting to measures that prolong life, such as cardiopulmonary resuscitation (CPR), respirators, feeding tubes, and dialysis.

Advance Medical Directives Tips

Here are some brief, easy-to-reference tips for advance medical directives.

• Plan to review your directives if moving to a new state.

• Sort out your feelings and beliefs. Make sure your advance directives reflect the values you live by (what’s most important to you)—for example, the way you feel about death, dying, pain, and suffering, as well as your moral and religious beliefs.

• Talk about these issues with people who matter to you the most: your spouse or partner, family members, friends, clergy, and heath care provider(s).

• Choose your proxy (agent) carefully. Be sure that he or she is totally committed to carrying out your wishes. Also consider naming a backup proxy in case your first pick is unable or unwilling to carry out your wishes.

• Change your proxy (agent) if you need to. Consider naming an alternative proxy in case your proxy moves, becomes ill, or dies.

• Get your directives reviewed before signing. Before you sign your advance directives, ask your proxy and health care provider to review your documents with you.

• Be sure to have your forms witnessed or notarized if required by your state.

• Keep the original forms in a safe, easy-to-reach place (such as your Health Power 101 Organizer). Give copies to your proxy, health care provider, hospital, nursing home, or anyone else who might be called in an emergency.

• Plan for an emergency. Keep a card in your wallet stating that you have advance directives and where they are located. (Your advance directives are included on your Wallet Health ID Cardô.)

• Change your directives, if you need to. Be aware that you have the right to change your advance directives at any time, even if you’re in the hospital, as long as you have the capacity to understand your health condition and the consequences of your choices and able to express your wishes. If you do change them or revoke them, be sure to destroy the old copies and tell your doctor and anyone else who has a copy of your advance directives.

• Review your directives every five years so that they always reflect what you want.

• Always travel with your directives. Your advance directives will likely be valid in other state.

Common Terms Used in Advance Directives

As you consider preparing an advance directive or as you try to work with your loved one, it’s helpful to have an understanding of the terms frequently used in these documents.

Here they are:

• Cardiopulmonary resuscitation (CPR). Procedures to restore stopped breathing and heartbeat: artificial breathing, chest compressions, and electrical heart shocks.

• Coma. A sleep-like state from which a person cannot be awakened.

• Do not resuscitate (DNR) order. An order signed by a physician to prevent CPR from being performed.

• Irreversible brain damage or disease. Permanent changes that affect a person’s ability to think and communicate.

• Life-prolonging measures. Any treatment or procedure to extend life, including artificial nutrition/hydration, respirators/ventilators (machines to keep patients breathing) and dialysis (a special procedure that uses a machine to clean the blood when the kidneys are not working properly).

• Palliative care. Measures to relieve pain and suffering, but not to cure.

• Persistent vegetative state. A permanent coma.

• Terminal illness/terminal condition. A condition in which the patient is expected to die within six to twelve months.

Jeffrey Brown, M.D., is certified by the American Board of Internal Medicine and licensed in the state of Maryland. As a physician, author, and professional speaker his central goal is to help bridge the gap between what doctors know and what patients understand. In addition to authoring Health Power 101: the Complete Guide to Patient Empowerment and Health Power 101 Organizer, Dr. Brown is also the founder and president of Health Power 101 Seminars, LLC, which has been created to empower patients, caregivers, and health-conscious individuals to take charge of their health. His website is HealthPower101Organizer.com