Advisory from (CHEC √) about Advance Health Care Directive
We believe that making an ‘Advance Health Care Directive’ is an important Responsibility for all adults, just as is practicing good health habits, developing mature relationships and values, educating your children, financial and insurance planning, and being an informed voting citizen.
I. Approaching the Process
The Advance Health Care Directive is a process and should not be regarded as “just filling out a form.” It requires time, thought, and conversation with family, friends, your doctor and, sometimes, your lawyer. It involves reflection on your life, your basic values and your goals. It also involves accepting the universality of death, and the inability of modern medical care to cure, or even substantially improve, many conditions. Most of all, it allows freedom to make your own health care decisions while you are physically and mentally able to do so and to name someone to make your decisions for you when you cannot.
II. Talking with your physician
Completing a Advance Health Care Directive without discussing it with your doctor is like setting sail on an ocean voyage without maps or compass. You need a guide to tell you what your clinical situation may be, what the treatment options are, and what is your prognosis for life and quality of life. It is important that choices are not vague such as “no heroic or no extraordinary treatment,” since these terms are open to varied interpretations. You need your doctor’s help to be specific. . You also need to be certain that your doctor either agrees with your choices or at least will comply with what you choose (if it is medically reasonable.) [No ‘heroic treatment’ may mean no cardiac resuscitation to one person and no feeding tube to another]
III. Appointing a substitute decision maker
- When you think about appointing a substitute decision maker, it is essential that you spend some time with that person talking about your values, goals and desires. He or she is required to act according to your stated wishes but there may be circumstances in which your wishes are not precise enough or do not apply in your situation and your substitute needs to act “in your best interest”. Some people may not share your ideas for religious, cultural or other reasons and their appointment may not be appropriate for you. Others do not want this responsibility.
- You should try to choose a person who is younger than you, lives in your vicinity, and is usually reachable. [It is of no use in a critical situation to find that the person you named has died, or moved without leaving a new address]
- You should name an alternate with whom you also should have the same discussion.
- Most often a spouse or close relative is named. When there are no appropriate or willing relatives, a friend or a neighbor or a trusted professional can be chosen. [Family circumstances may produce a rift or disagreement among the children and the spouse, which could lead to inaction]
IV. Reexamining your Advance Directive
Your document, when prepared according to the law, except for those made before 1992, does not expire. But things will certainly change. Your ideas may change, your substitute may no longer be competent, willing or living. Medicine will advance. The laws may change. Reexamine your Advance Directive periodically to accommodate a change and re-sign with the new date if older than 1992. [If you are mentally and physically able, you may change your mind at any time simply by telling your doctor or hospital]
V. Providing copies to appropriate people
These people need to have a copy of your Advance Directive.
- Your primary care doctor for his office records
- Your hospital or nursing home admitting office
- Your decision-making agent and all the alternates
- You need several readily available copies yourself
- Anyone else you think you want to know, e.g. your spouse, lawyer, business advisor etc.
[One recent experience pertinent to this was that of an elderly lady who completed the Advance Directive, locked it in her safety deposit box, didn’t provide any copies to anyone, came to the hospital confused, and did not have her medical wishes fulfilled]
VI. Availability of many different Advance Health Care Directive forms
There are many legal forms available for advance directives and they are basically the same. Your lawyer dealing with your will and end-of-life planning may wish to write a document specifically for your purposes. There is also a simple and less formal health care advance directive in which you simply tell your doctor what you do and do not want in certain circumstances, he enters it in your chart, dates it, and you sign it. A discussion with your doctor and your loved one should precede this statement. [This format is more “contested” than the standard forms but better than nothing.]
VII. Naming a Temporary Surrogate
To provide another option, California law permits an adult patient to name another adult to act as a surrogate on the patient’s behalf. A surrogate may be named even if the patient has already named a different person as Agent in the Advance Health Care Directive. In that case, the surrogate has priority over the Agent in making care decisions for the period of time that the surrogacy is in effect. A patient may name a surrogate by notifying his or her primary physician orally or in writing.
The designation of a surrogate is effective only (1) during the course of treatment or illness, (2) during the stay in the health care institution when the surrogate is named, or (3) for 60 days, whichever is shortest. The patient may designate a shorter period.
The surrogate must make decisions consistent with any written or oral instructions of the patient and with any other known wishes of the patient. If the wishes are unknown, the surrogate must act in the patient’s best interest, taking into consideration the patient’s personal values known to the surrogate
The Advance Health Care Directive discussion and form exists to protect your freedom of choice and your autonomy. It also may help an anxious family and doctor know your wishes.
