Law & Legal & Attorney Wills & trusts

Living Will, Medical Power of Attorney, Advanced Directives and Ethical Issues

Advance Directives help family members and medical professionals know a person's medical care preferences.
These documents take effect when someone lacks the ability to make informed health care decisions for themselves.
There are three main forms of medical advanced directives.
The first is a Living Will, which is a document that states a patient's preferences in a variety of medical situations.
The second is a medical durable power of attorney,also known as durable power of attorney for health care.
A durable power of attorney assigns someone the authority to make medical decisions on your behalf.
The third type is a Do Not Resuscitate Order.
This document only takes affect if life-saving measures are needed.
It has no power to "pull the plug" or enforce other instructions.
Writing advanced directives can be difficult.
While living will forms and medical power of attorney forms are free and available from many locations, they may not be sufficient.
It is often the specific wording that goes into the blanks on those forms that is the problem.
Do you want a general statement of your desires such as "I want to pursue all forms of treatment"? Do you want specific instructions like, "I want all life-sustaining procedures to be discontinued after thirty days when my medical condition has shown no signs of improvement?" General statements can be problematic because they often allow debate about the individual's intention.
What is meant by "treatment," for example? Does it mean medical procedures that improve the underlying medical condition or does it also include all life-sustaining efforts? Specific statements can also be problematic.
No matter how exhaustive the list, there can be a situation that does not directly parallel with the medical condition that instructions have been given for.
Additionally, documents that are not updated regularly will be silent on new medical advances available for treatment.
Another challenge is the substantive choices made in the advance directive.
The continuum of circumstances addressed in your advance directive can range from facility and doctor preferences to specific do not resuscitate orders.
Treatment for medical conditions, life-sustaining measures, the circumstances for withdrawing treatment, organ donation, contributing to medical research, and instructions that some may consider "assisted suicide" may give rise to multiple forms of debate.
Spiritual considerations of the patient, the doctor, the facility, professional obligations of medical professionals, the fear of medical malpractice claims by persons interested in the patient, and financial considerations ranging from insurance coverage to end-of-life care impacting an estate are also a few of the competing interests that may impact a document's instructions.
Selecting Medical Power of Attorney Proxy Along with content are the challenges associated with determining who will act as your proxy.
Selecting a person who will be in your life when the need for the advance directive arises and who will know your wishes is very important.
The proxy should be someone who is close to you such as a partner, child, sibling.
However selecting a person who is close to you to serve as the proxy places an additional stress on that individual in a time that quite often feels like chaos.
It also asks a loved one to carry not only the responsibility but the burden of your choices as well.
Asking a spouse to withdraw treatment, also asking them to continue on with living after having been the one who withdrew your treatment.
When selecting a proxy consider their ability to navigate family system dynamics.
Can the individual withstand the scrutiny and emoting of family members who want different choices to be made on your behalf? Does your proxy have a financial interest in your estate that could make him or her open to a challenge by other heirs? It is essential to communicate your wishes with a proxy.
Those discussions can be difficult particularly when your wishes fall outside the family's usual beliefs.
Though advance directives are difficult and potentially problematic for the patient, patient's loved ones, medical providers and the facility, having a valid advance directive is essential to maintain control over quality of life when capacity to make medical decisions is diminished.
For those who wish to proceed with an advance directive, begin by learning what forms of advance directives are utilized in your state and what is required to create a valid advance directive.
Finally, speak openly with your medical providers, proxy and other loved ones to promote a general understanding of your wishes.
A doctor and spouse who are both on the same page regarding your wishes will make things much easier.


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