Taking Control: An Introduction to Advance Health Care Directives
Introduction
Do you want to live forever? Unless you’ve recently stumbled upon the philosopher’s stone or discovered the fountain of youth, your answer is likely no. Despite our best efforts and the remarkable progress in medical science and technology, our bodies have no defense to the infirmities that accompany old age. Gradually, we find ourselves relinquishing certain faculties, eventually succumbing to the passage of time. While we may not dictate the timing or manner of our departure, we can take control of our end-of-life healthcare decisions. Advance health care directives, which include living wills and Do-Not-Resuscitate orders (DNRs), are legal documents that allow you to plan the health care treatment you will receive during your final days.
Living Wills
A living will is a legal document that allows you, as the principal, to record your preferences regarding specific medical treatments and procedures if, in the future, you end up with an end-stage medical condition or are permanently unconscious. The medical treatments and procedures indicated on a living will run the gamut and include, but are not limited to, organ donation, cardiac resuscitation, mechanical respiration, feeding tubes and other forms of artificial nutrition, hydration, blood products, surgery, diagnostic testing, kidney dialysis and antibiotics. Your decisions should feel right to you. Whether you choose to receive or opt out of a specific medical treatment or procedure is a personal decision. There are no right or wrong answers.
Most living wills allow you to designate a friend or family member as a health care surrogate, someone who can alter your decisions about whether you receive specific medical treatments and procedures. Many of our clients want their partners and children to participate in the decision-making process and choose to list those individuals as health care surrogates. Others choose not to delegate any health care surrogates. Some believe asking another person, especially a loved one, to make these types of decisions is too much of a burden. Some don’t want anyone altering their choices. Ultimately, whether you choose to designate a health care surrogate is up to you.
To ensure your living will is complied with, your living will must meet certain requirements under state law. In Pennsylvania, a living will must be dated and signed. Although your signature must be witnessed by two individuals, it does not need to be notarized. Once you execute a living will, it will remain valid until you revoke it. And unlike certain other estate planning documents, you can make changes to your living will after you’ve executed it. If you change your mind regarding a specific medical treatment or procedure in the future, you can change your selection directly on your document.
It’s important to remember that the applicability of your living will is limited. Your doctor will only review your living will (1) during your last stage of life and (2) if you are unable to communicate or are unconscious. For most people, their last stage of life is not tomorrow. If a person breaks a few bones and ends up in the ER, their doctor isn’t going to euthanize them because they executed a living will the week prior. And if you can communicate during your last stage of life, whether it’s vocally or with a dry-erase board, your doctor will follow your instructions regardless of whether you have a living will.
Do-Not-Resuscitate Orders (DNRs)
A Do-Not-Resuscitate order (DNR) is a legal document that allows you, as the principal, to indicate your desire to not be resuscitated if you suddenly require life-sustaining medical treatment. Although your attorney can supply you with a DNR form that meets certain state-specific requirements, you cannot execute a DNR at a law office. In Pennsylvania, a DNR must be signed by a medical doctor. Those who request a DNR tend to be terminally ill, are in severe pain, or desire to have a natural death. If someone is dying of cancer, having a DNR can offer the person a sense of control. Furthermore, resuscitation can be painful and those who are resuscitated may have suffered brain damage. Once a patient obtains a DNR, only the patient can revoke the order.
Medical professionals must comply with a DNR if they are aware of the patient’s DNR status and the DNR meets all statutory requirements. Some patients notify medical professionals of their DNR status by wearing a necklace or bracelet indicating that a DNR has been executed. Under Pennsylvania law, the necklace or bracelet must clearly state “Out-of-Hospital DNR” and include: (1) the name of the patient and (2) the name and dated signature of the physician that signed the DNR. If you to choose to wear a necklace or bracelet, you want to ensure that an emergency medical service provider has no reason to question the validity of it. If an emergency medical technician (EMT) is uncertain about the validity or applicability of a DNR and they are acting in good faith, the EMT may render life-sustaining medical treatment and remain immune from civil and criminal liability.
Conclusion
Advance health care directives empower individuals to articulate their medical treatment preferences and end-of-life health care. By delineating these preferences in advance, individuals safeguard their autonomy and dignity during critical life stages. If maintaining control over health care decisions is important to you, you should consider augmenting your estate plan with these types of documents. Understanding the purpose, content, and legal implications of an advance health care directive is crucial. Seeking guidance from legal professionals well-versed in estate planning and advance directives can provide invaluable assistance in crafting a comprehensive estate plan that aligns with your personal values and preferences. With a carefully constructed living will in place, you can have peace of mind.