Advance Directives

Over the past few weeks the news has been filled with the controversy over Terri Schiavo. Clearly this has been a painful situation for her husband and family and a thought-provoking issue for the entire country. The important lesson to be learned is that this situation is now largely avoidable for those who have planned ahead and prepared the appropriate legal documents.

An advance directive is a legal document that helps to ensure that your health care wishes will be respected if you become unable to speak for yourself. There are two basic types of advance directive: a living will and a health care proxy. A living will documents your personal wishes about end-of-life medical treatment. A health care proxy, or durable power of attorney for healthcare, appoints someone else to speak for you if you are unable to speak for yourself. While these forms may seem redundant, it is useful to have both.

Making decisions about end-of-life care are difficult and can be even more difficult when these decisions are put in the hands of someone else. The Massachusetts Medical Society has created a discussion guide to help patients and their proxies formulate these decisions. The following questions are taken from that guide:

1. What makes life meaningful or good for you now?

2. What, if any, religious or personal beliefs do you have about sickness, health care decision-making or dying?

3. Can you imagine any circumstances in which life would be so unbearable for you that you would not want medical treatments used to keep you alive?

4. If your spokesperson ever had to make a medical decision on your behalf, are there certain people you would want your spokesperson to talk to for advice or support?

5. Is there anyone you specifically would not want involved in helping to make health care decisions on your behalf?

6. Should financial or other family concerns enter into decisions about your medical care?

7. How closely would you want your spokesperson to follow your instructions about care decisions, versus do what they think is best for you at the time decisions are made?

We would recommend a thoughtful consideration of these questions and then discussion with your family and health care agent to ensure that you are all in agreement.

Each state has its own regulations regarding these forms. Massachusetts state approved health care proxy forms can be downloaded for free on their website.

Every person over 18 is entitled to fill out these forms. In the past, the medical establishment only encouraged the elderly or terminally ill to fill out these forms, but we have learned from situations like Terri Schiavo’s that they can be beneficial for everyone. Like a last will and testament, changes can be made to these forms at any time. It is recommended to keep a copy of these forms in a secure, but accessible, location as well as to provide copies to us (your primary doctor), your family and your health care agent. You may also wish to provide a copy to your lawyer.

As always, please let us know if you have any questions or concerns.