Health Care Directive

A Living Will is your set of written instructions stating when you do and don’t want artificial life support. A Living Will usually applies only to a few decisions that may be made at the end of life. It does not name another person to make health care decisions for you; instead, as long as your doctor has a copy of it, this document allows you to make your own artificial life support decisions.

By contrast, a Health Care Power of Attorney (sometimes called a Health Care Proxy) is a document that allows you to authorize a person you trust (your “health care agent”) to make health care decisions on your behalf in the event that you are unable to do so. Unlike a Living Will, which is primarily meant to cover end-of-life decisions, a Health Care Power of Attorney allows someone you trust to manage your health care in any situation where you are incapacitated and unable to make decisions concerning your own health care.

A Living Will is a document that includes your instructions about what kind of artificial life support you want (or don’t want) if you cannot direct your own health care and are dying or in a coma condition.

A Living Will generally only covers situations in which your situation is so dire that medical professionals have determined that there is no reasonable chance that you will recover. In these situations, important decisions about artificial life support need to be made. Choices about artificial life support are deeply personal: they involve your personal and family values, your religious beliefs, how much invasive tube feeding or hydration you want, and your feelings about dignity at the end of life. In these types of situations, your Living Will communicates your wishes to your doctor, family and loved ones.

In addition to instructions about life support, your Bloomwell Living Will can contain your instructions regarding organ donation, pain medication, the people and experiences you want to have at the end of your life, and any increased visitation rights you may want to grant to loved ones.

Different states use different terms to describe artificial life support. These include terms like life-prolonging treatment, death-delaying treatment, and life-sustaining treatment.

Artificial life support generally includes any medical procedure or treatment that sustains or replaces a natural vital function, such as breathing. Artificial life support usually does not refer to medical procedures or treatments that are meant to provide comfort or alleviate pain. Artificial life support can include artificial nutrition and hydration.

Your choices about artificial life support are included in a Living Will.

Generally, your Living Will will be used by your health care provider when you cannot make or communicate your own healthcare decisions and when you are either expected to die within a short time frame from an incurable condition or are in a coma condition from which you are not generally expected to recover. Medical professionals are required to determine whether you are in one of these medical conditions.

States have different ways of phrasing or describing when someone is in a state where a Living Will applies. Even if you instruct that your life support be discontinued, some states will not honor your request if you are in a permanent coma or a similar coma condition. In those states, you must also be dying from an injury or disease before your request to discontinue life support will be honored.

If you want to know exactly how your state describes the conditions in which your instructions to discontinue life support will be honored, you should contact a health advocate, your health care provider, or an attorney.

You may revoke your Bloomwell Health Care Directive at any time.

Being incapacitated generally means that you are unable to make or communicate decisions for yourself and are unable to manage your affairs. Incapacity is determined by the examination of one or more medical professionals, but the exact requirements will vary from state to state, as state laws may describe incapacity in their own words.

Generally, Living Wills and Health Care Powers of Attorney do not go into effect until a person has been professionally determined to be incapacitated and unable to direct his or her own health care. This is because if you are able to direct your own health care, then your doctor and family can ask you what you want -- they don’t need a document to tell them. Similarly, if and when you regain the ability to competently direct your own health care, you can resume making your own decisions.

Generally, this document gives your agent broad authority to make health care decisions for you, unless you limit his or her authority in the Health Care Power of Attorney document. Although your agent has broad authority, he or she must follow your wishes as set forth in the Living Will portion.

You should also remember that your agent’s authority will remain unless you revoke it.

State laws may restrict you from appointing certain people as your agent, such as your doctor or an employee or operator of your health care facility.

In most states it is illegal for your doctor or an employee/operator of your health care facility to serve as your agent. This is because of the possibility that a conflict of interest could arise if any of these individuals served as your agent.

A Health Care Power of Attorney is generally valid from the date it is executed until the date that it is revoked by you.

The law regarding Health Care Directives varies from state to state. Therefore, if you split your living time between states, you should consider making a separate Health Care Directive for each state or consult with a lawyer or health care advocate for advice.

No, a DNR order is usually written by a physician after a patient (or a patient’s authorized health care agent) has indicated that the patient does not want to be resuscitated under certain circumstances. Many states have very specific DNR protocols, and DNR orders are often written on special forms provided by the hospital or state. If you are considering putting a DNR order into place, you should check with your hospital or discuss with your doctor.