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Advance Directives provide patients a voice when they can’t speak

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Tom Wulf, MD

Most people don’t like to think about being severely ill or incapable of making decisions about their own health. Yet, accidents can happen to people of all ages. You could suddenly become incapacitated by an accident or illness, or by a condition that could render you unable to make decisions. This is why it’s so important that adults of all ages have advance directives in place.

An advance directive is a legal planning tool to express your preferences for medical treatment and the handling of your affairs, in the event that you’re unable to make decisions due to a serious illness or injury. It speaks for you in the event that you’re unable to speak for yourself (for example, a coma), and will greatly help in decision-making during times when making a choice may be difficult for your family.

Information in advance directives cover the types of treatment you want – or don’t want – if you become unable to make or communicate lucid medical decisions. Advance directives can be short and simple statements, and they can be changed or canceled at any time. These documents are usually prepared in conjunction with an attorney and your family. Your doctor can also help answer questions and aid in your advance decision-making process. Your attorney may recommend that your advance directive be notarized. If you do make changes, be sure to notify your doctor and family. You can also make verbal changes while you are in the hospital.

An advanced directive can take several forms.

Living Will

A living will is a legal document stating your wishes for – or against – life-saving medical treatment or intervention if you were to be seriously or terminally ill. These interventions may include artificial nutrition through tube-feeding, prolonged maintenance on a respirator if you are unable to breathe on your own, diagnostic tests, palliative care, and organ or tissue donation. A living will protects the patient’s rights and removes the decision-making burden from family, friends and physicians.

An important distinction to understand about a living will is that the decision not to receive “aggressive medical treatment” is not the same as deciding to forgo all medical care. A patient can elect to receive palliative care – antibiotics, nutrition, pain medication, and radiation therapy – with the goal of helping the patient remain comfortable, rather than focusing on a cure.

Most states require that a living will be witnessed and notarized when signed. It’s a good idea to make copies of the document and keep the original in a safe place, and to consider carrying a card in your wallet that states that you have a living will.

Durable Power of Attorney

A durable power of attorney for health care, also called medical power of attorney, allows you to select someone to make health care decisions – designated in your living will – in the event you are unable to do so. It goes into effect any time you are not conscious or unable to make your own medical decisions. The DPA gives another person the right to make only medical decisions for you, not legal or financial decisions. However, a person can appoint someone to manage their finances for them through a durable power of attorney for finances.

Do Not Resuscitate (DNR)

A do not resuscitate (DNR) order communicates your wishes not to be revived if your breathing or heartbeat stops. Unless hospital staff has orders from the patient that states they do not want to be revived, they will always attempt to help patients whose heart has stopped or who have stopped breathing

Laws about advance directives differ in each state, so it’s a good idea to seek legal advice, or at least have your advance directive reviewed by an attorney.

Tom Wulf, MD is the medical director for Eastern New Mexico Medical Center’s emergency department. The advice offered in this column is that of the author.