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What's an Advance Directive?

Medical Treatment Decisions for a Living Will

When his or her condition is terminal and death is certain, does your parent want …

  1. Cardiac resuscitation (CPR)?
  2. Mechanical respiration (breathing machine)?
  3. To receive food and water via a feeding tube or intravenously when he or she can no longer eat or swallow?
  4. Blood products (transfusions)?
  5. Any surgery or invasive diagnostic tests?
  6. Kidney dialysis?
  7. Antibiotics?
  8. To be taken to the hospital?
  9. Life-sustaining treatment stopped if it has been started?

It is also important to spell out in the living will what your parent does expect from medical caregivers. For example: Mom doesn't want to be in pain; she doesn't want anything done to intentionally end her life; she wants to be kept clean and warm and offered food and water by mouth.

Geri-Fact

DNR orders stand for “do not resuscitate” This notation is written by a physician on a patient's medical record. It lets all health care staff know that if the patient stops breathing or his or her heart stops beating, no one will try to revive the patient. The DNR term might also be referred to as a “no code” order. DNR orders can also be given to EMTs (also known as emergency medical technicians or paramedics) to release them from the obligation to resuscitate. You must show them, however, an executed legal document. You can call Choice in Dying at 1-800-989-9455 to get a copy. By law, a person must be resuscitated unless the health care staff are given the executed legal document specifying otherwise.

Not all living wills specify the need for a surrogate decision maker on your parent's behalf. If a living will is very thorough with specific instructions, a surrogate won't be necessary.

Your parents will need to sign their living wills in front of witnesses. Each state specifies who are considered acceptable witnesses, so be sure to find out your state's rules.

It's a general rule of thumb that witnesses should not be family members, health care providers, or anyone with a financial stake in your parents' estate. Some states require the living will to be notarized. Even if they don't, it doesn't hurt to have the will notarized anyway.

Durable Health Care Power of Attorney

So what's the difference between a durable health care power of attorney and a living will? The living will centers on end-of-life decisions. The medical treatments called into question focus on sustaining life when there's no hope for recovery or death is certain.

The durable health care power of attorney is broader than a living will. It empowers the agent to make health care decisions on behalf of your parent any time your parent becomes incompetent. The agent can make decisions on admissions and discharges to and from health care facilities, what to do with medical records and organ donations, whether or not to move the patient, make arrangements for home health care and accept or refuse treatment that affects the physical and mental health of the patient. Furthermore, these medical decisions are for all levels of health care—not just focused on impending death.

Again, each state has its own laws governing durable health care power of attorney. Many documents granting this right also have a living will section.

Geri-Fact

If your parents change their minds and want life-sustaining procedures done, living wills and a durable health care power of attorney can be revoked. For most states, people can execute a new living will that cancels out their old one, or state in writing that they revoke their current living will. Copies of this statement should be given to anyone who received the former living will. To avoid any debate, get the new will notarized.

Here are some of the basic tenants of durable health care power of attorney:

  • You don't have to be a lawyer (whew!) to be designated as having durable health care power of attorney on behalf of your parent. The word “attorney” simply means “designated agent.”
  • The power of attorney does not kick in until your parent is legally incompetent! As long as Mom and Dad are competent, they make the decisions.
  • Your parents must be competent when they complete and execute the durable health care power of attorney papers. This will not be considered legal if you're doing this at Dad's bedside after he's just suffered a major stroke or has been diagnosed with Alzheimer's. If there's any question regarding your parent's competency, see a lawyer. You may need to get a written opinion from a doctor.
  • When a patient is unable to give informed consent (such as during anesthesia), the durable health care power of attorney takes effect.
  • Many states have laws that spell out procedures for determining when someone is legally incompetent. You and your parent should be familiar with what is required. Usually physicians and lawyers become involved in this determination.

You might find that your state refers to the durable health care power of attorney by different names, such as health care proxy, health care agent, medical power of attorney, or attorney-in-fact. For more information and forms regarding durable health care power of attorney, contact Aging with Dignity or Choice in Dying, Inc..



More on: Aging Parents

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Excerpted from The Complete Idiot's Guide to Caring for Aging Parents © 2001 by Linda Colvin Rhodes, Ed.D. All rights reserved including the right of reproduction in whole or in part in any form. Used by arrangement with Alpha Books, a member of Penguin Group (USA) Inc.

To order this book visit the Idiot's Guide web site or call 1-800-253-6476.


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