Advance directives and living wills are documents that provide legal instructions about medical care preferences for people who are not able to make decisions on their own. If a person becomes terminally ill, develops dementia or is seriously injured, these documents provide instructions for what types of care to give or withhold. Advance directives and living wills are important for adults of all ages.
There are power of attorney forms for medical purposes, and they may also be called durable power of attorney or health care proxy forms in some states. A medical power of attorney document gives a designated person the ability to make medical and health care decisions on behalf of the document creator if he or she becomes mentally incapacitated. Most people choose a family member, a trusted friend or a clergy member to name on a power of attorney document. Several alternate people can be named in the event that the designee is unable to fulfill the role. It is important to name people who are willing, able and meet the state's requirements for being a health care agent. Do not choose a personal doctor or a member of a personal medical care team.
This legal document reflects the wishes of the creator about medical treatments that he or she would or would not want to use to be kept alive. For example, ventilators, breathing tubes and feeding tubes are used to keep people alive in some situations. Some people may want to avoid these items and possibly die instead of being in a vegetative state for an undetermined amount of time. Living wills also reflect wishes about organ donation, pain management and other important issues. The specifications in a living will should be the personal wishes of the creator. When unsure about what to do or what each option entails, discuss the issues with a personal primary doctor. The following are some important issues to discuss with a doctor:
- How long to stay on a mechanical ventilator
- How long to be fed using a tube or possibly not allowing a tube at all
- How long to receive dialysis if it is necessary
- Whether to use antibiotics during end-of-life care
- Whether to use palliative measures for end-of-life care
- Whether to donate tissues, organs, skin and corneas
- Whether to be buried, entombed, cremated or donated to science after death
- Whether or not to allow resuscitation to restart the heart in different situations such as surgery or sudden emergencies
In choosing to be an organ donor, a person can potentially save five or more lives. With organ donation, keep in mind that the donor must be kept alive while the organs are harvested. The individual is not conscious and does not feel any pain from this procedure. This should not discourage generous people from choosing such a selfless last act of charity. However, it is important to be aware of the process. This particular measure is necessary to preserve the organs and keep them functioning properly for the recipients who need them. To have a body donated to science, contact a local university or medical school to learn about options.
DNR And DNI Orders
There is no need to have any advance directives to create orders against resuscitation or intubation. To avoid a breathing tube or resuscitation, talk to a primary physician. The physician can write these in a person's medical record as orders, and they will appear when doctors in hospitals or other medical facilities look up the patient's record before providing care. Also, mention the existence of a living will if it has already been created.
When setting up plans for advance directives and end-of-life care, be sure to discuss them with family members. Creating these plans takes the mental burden and stress away from family members and prevents them from having to make hard decisions at difficult times. Also, discuss the role of health care agent with them, and only designate those who are willing and capable of possibly fulfilling the role.