Do You Understand Your Loved One’s Advance Directive?
If a parent or senior loved one appointed you in an advance directive to make his or her medical decisions, would you know what to do? In a medical crisis, even straightforward instructions may seem ambiguous when you’re the one responsible for life-and-death decisions.
“When someone is being admitted to the hospital, that’s not the time to ask questions about pull-the-plug decisions,” says Kyle Krull, an estate planning attorney in Overland Park, Kansas. “It’s important to find out in advance what that person would want or not want under a variety of scenarios… When it comes to making life-or-death decisions for someone else, clarity is critical.”
The Types of Advance Directives
Just when you think your 80-year-old mother, who struggles with congestive heart failure, is doing well, your cell phone rings on an otherwise typical morning. Mom had a massive stroke at breakfast, a nurse at her assisted living community tells you. “She’s at the emergency room.”
When you arrive at the hospital, you learn that your mother went into cardiac arrest. If her heart stops again, should doctors try to restart it to save her life? Her attending physician wants to know. What do you say?
Advance directives allow a person to provide consent for an appointed agent to continue, withdraw or withhold certain medical treatments should that person become incapacitated and unable to make his or her own health care decisions.
“There are many different roads with advance directives, but they all lead to the same result, which is having control over your own health care decisions when you don’t even know what’s going on,” says Krull.
Types of advance directives vary according to state law, but here are the two most common:
1. Durable Power of Attorney for Healthcare
The durable power of attorney for health care is also known as the health care power of attorney, health care proxy or medical power of attorney.
The durable power of attorney for healthcare is a legal document that allows a person named as the agent or proxy to make medical decisions for another person, known as the principal, based on that person’s instructions, if he or she becomes incapacitated and unable to make his or her own decisions.
2. Living Will
A living will is a legal document intended to guide health care decisions for a person who is no longer able to make his or her own choices. While state laws vary, a living will is similar to, but much more limited than, a durable power of attorney for health care, because a living will may be used only if the person also has a terminal illness or permanent unconsciousness, also known as a persistent vegetative state.
Another type of advance directive is the Do Not Resuscitate (DNR) order. A DNR order stops medical staff from restarting a person’s heart or other life-sustaining measures such as breathing machines. A DNR, sometimes called an “Allow Natural Death” order, is only valid while a patient is in a hospital.
However, in some states, a person can get a Do Not Attempt Resuscitation (DNAR) or special DNR order that applies outside the hospital. The non-hospital DNAR and DNR are instructions for emergency medical teams such as paramedics or others that may answer 911 calls.
The best approach is to have at least two documents, a health care power of attorney naming a trusted person to enforce the wishes of your loved one when he or she is unable to make health care decisions and a living will.
These two functions can even be combined into a single document such as Five Wishes, a form that addresses emotional, personal and spiritual needs along with medical wishes and burial or cremation preferences.
The Five Wishes document is legally enforceable in most states. If the state where your loved one resides doesn’t recognize this form, that person can still complete the form to guide family members with future medical decisions.
Why Communication With Your Loved One Is Key
Just because you have copies of your parents’ advance directives doesn’t mean you’ll understand what they want for every possible scenario. If you’re the agent named to make medical decisions for a senior loved one, it’s crucial for your loved one to communicate personal preferences with other family members.
“Everyone in the immediate family orbit needs to know what a parent’s wishes are,” says Krull. In some states, the person appointed to make medical decisions also has the right of sepulcher, which is the authority to choose burial, cremation or other final disposition of the principal’s body.
“If you want to see World War III break out, just watch a group of grieving siblings try to decide whether to bury or cremate their parent when no prior guidance has been provided…” says Krull.
When you discuss your loved one’s advance directive, find out as much as you can about what he or she would want in various situations.
Questions to ask include:
- Do you want to be buried, cremated or use some method of body donation? Do you want to donate organs or tissues?
- Do you want to receive fluid intravenously (IV) or nutrition with a feeding tube if you can’t drink or eat on your own? If you will never again be able to drink or eat on your own, at what point do you want to stop intubation?
- How do you feel about the use of equipment if your kidneys or other organs shut down or you can’t breathe on your own and the condition could be long-term?
- If your breathing or heart stops, do you want paddles or CPR used to bring those functions back?
- What if you have a serious illness like Alzheimer’s, cancer, chronic obstructive pulmonary disease (COPD), congestive heart failure, kidney disease or Parkinson’s? Would you want palliative care to help relieve pain and keep you comfortable?
There is no way to know what someone might want in every possible situation, but a frank discussion now with your parent or senior loved one can reveal information that could help you with weighty health care decisions later.
“Just like the three rules of real estate are location, location, location, the three keys to successfully advocating the health care wishes of your loved one are communication, communication, communication, starting on the day you are first appointed to carry out those future wishes,” says Krull.
Has a parent or senior loved one appointed you in an advance directive? We’d like to hear your stories in the comments below.
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