reviewing
your advance directive
In the words of former Supreme Court Justice Benjamin
Cardozo, “Every human being of adult years
and sound mind has a right to determine what shall
be done with his own body.” Health-care
advance directives are legal tools that enable you to choose
one or more people to make health-care decisions
on your behalf when you cannot speak for yourself.
A living will is a type of health-care advance directive.
A living will is simply a written instruction spelling
out any wishes you have about your treatment or care
in the event that you are unable to speak for yourself.
A living will says, in effect, “Whoever is
deciding, please follow these instructions!” On
its own, a living will is very limited—it usually
applies only to end-of-life decisions.
A health-care power of attorney (also known as a
health-care proxy or medical
power of attorney) is
another type of advance directive. In a health-care
power of attorney, you appoint someone of your choosing
to be your authorized agent to make decisions about
your health. You can give your agent as much or as
little authority as you wish to make health-care
decisions; the decisions are not limited to end-of-life
decisions. Appointing someone as your agent provides
that person with the authority to weigh all the medical
facts and circumstances and interpret your wishes
accordingly. A health-care power of attorney is broader
and more flexible than a living will.
Some lawyers recommend that you create a comprehensive
health-care advance directive, which combines the
living will and the health-care power of attorney
into one document. The document may also include
any other directions you wish, including your choices
about whether to donate or receive organs and where
and how you prefer to be cared for.
When planning for future health-care decisions, it
is important to understand that merely completing
a health-care advance-directive will do very little
good if you skip the most important part of the process:
reflecting on what you want and discussing what you
want with your family. In order to be effective,
the planning process requires that you share your
wishes, fears, and priorities with your physician,
family, and whomever else you will choose to speak
for you when you cannot. Think of the process as
a continuing conversation that you will likely need
to have more than once. After all, your views may
change as you age, and may change dramatically in
the event of serious illness. For example, your thinking
about end-of-life options would probably be different
if you were a healthy 35-year-old than if you were
a chronically ill 85-year-old. An advance-directive
should be looked at as a work in progress that may
be modified at various turning points in your life.
Reviewing Your Advance Directive
Priorities and goals change as your life circumstances
change, so review your health-care advance directive
with your family and your lawyer periodically.
Such review is particularly important when you
experience any of so-called Five Ds:
1. Decade—when you start a new decade of your
life;
2. Death—when you experience the death of a
loved one;
3. Divorce—when you experience a divorce or
other major family change;
4. Diagnosis—when you are diagnosed with a
serious health condition; or
5. Decline—when you experience a significant
decline or deterioration of an existing health condition,
especially when it diminishes your ability to live
independently.
Crossing State Lines: Is My Advance Directive Still
Good?
Health-care providers normally try to respect your
wishes, regardless of the form you use to indicate
those wishes or the state in which you executed the
form. Only if you spend significant amounts of time
in more than one state do you seriously need to consider
executing an advance directive for each state. In
such cases, you should find out whether one document
will meet the formal requirements of each state.
As a practical matter, you may want to name different
agents if one agent is not easily available in all
locations. Generally speaking, your agent should
be physically close to your place of care.
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