What are advanced directives?

Remember the Terri Schiavo case? It lasted from 1990 to 2005 involving a battle between Terri’s husband and her parents on whether or not to remove her from life support. It was a very controversial case that brought about a lot of thought and discussion on the topic of Advanced Directives. Terri did not have a living will; if she did, it would have prevented this 15-year legal struggle. 

Two forms of advanced directives

• Durable Power of Attorney for Health Care empowers you to name an agent, a trusted friend or family member, to make health care decisions when an attending physician determines that you have lost the capacity to make informed health care decisions for yourself. It becomes effective only when you are temporarily or permanently unable to make your own decisions regarding treatment. It requires the person you appoint to make decisions that are consistent with your wishes. It will not overrule a living will.

• A Living Will is a binding legal document you can complete that declares what your wishes are regarding the use of life-sustaining treatment if you should become terminally ill or permanently unconscious. In both cases, two physicians, not just one, must agree that you are beyond medical help and will not recover. A living will becomes effective only when you are permanently unconscious or terminally ill and unable to communicate. It spells out whether or not you want life-support technology used to prolong your dying. It gives doctors the authority to follow your instructions regarding the medical treatment you want under these conditions. A living will can’t be revoked by anyone but you and you can change it at any time. A living will specifies under what conditions you would want artificial feeding and fluids to be withheld.

Which is better, a Health Care Power of Attorney or a Living Will?

Actually, it is a good idea to fill out both documents because they address different aspects of your medical care. A Living Will applies only when you are terminally ill and unable to communicate your wishes or if you are permanently unconscious.

A Health Care Power of Attorney becomes effective even if you are only temporarily unconscious and medical decisions need to be made. For example, if you were to become temporarily unconscious due to an accident or surgery, the person you name in your Health Care Power of Attorney could make medical decisions on your behalf.

Where can I get the documents?

You may obtain a copy of these standard Ohio forms by mailing a request along with $3 to the Midwest Care Alliance, 855 South Wall Street, Columbus, OH 43206, or download an advanced directives packet containing the forms on that organization’s website at www.ohpco.org​. Or you may choose to have your attorney draw up the documents. 

Make several copies. Give one to a trusted member of your family. Keep another with your personal papers. Leave copies with your physician and your lawyer, and, perhaps, your clergy person. Be sure to give a copy of your health care power of attorney document to the person you have designated to be your agent.

Terminology

Life-sustaining treatment: any medical procedure, treatment, intervention or other measures that when administered to you serves principally to prolong life

Hydration: fluids that are artificially or technologically administered through tubes

Nutrition" refers to food that is artificially or technologically administered through tubes

Permanently unconscious: to a reasonable degree of medical certainty: (1) you are irreversibly unaware of yourself or your environment; and (2) there is total loss of cerebral cortical functioning which results in your having no capacity to experience pain or suffering

Terminal condition: an irreversible, incurable and untreatable condition caused by disease, illness or injury from which, to a reasonable degree of medical certainty: (1) there can be no recovery; and (2) death is likely to occur within a short period of time life-sustaining treatment is not administered.

Comfort care: nutrition and/or hydration when administered to diminish pain or discomfort, but not to postpone death; and any other medical care that diminishes pain or discomfort like pain medication and turning a patient, but does not postpone death.