Advance Directives and Your Right to Make Medical Decisions
A Discussion on Advance Care Planning
Most American adults don’t have a will ready. A third don’t carry life insurance. Only one in five has told their friends and family how they’d like their own death dealt with.
What does a “good death” look like? How helpful can we expect the medical profession to be when the time comes – for example, respecting that DNR order, or talking frankly with us about what’s ahead? What can hospice offer a client and their family – and who’s lucky enough to have access to that?
- Chris Taich is with the non-profit Pathways Home Health and Hospice, where she’s the director of Clinical Support Services. She’s spent many years in social work, assisting clients with the dying process and grief.
- Dr. Ruchika Mishra is Senior Bioethicist with the Program in Medicine and Human Values at Sutter Health here in the San Francisco Bay Area.
Advance Directives and Your Right to Make Medical Decisions
Here we’ll explain your right to make healthcare decisions and how you can plan for your medical care if you are unable to speak for yourself in the future. This can increase your control over your medical treatment.
Who decides about my treatment?
Your doctors will give you information and advice about treatment. You can say “Yes” to treatments you want. You can say “No” to any treatment that you don’t want – even if the treatment might keep you alive longer.
How do I know what I want?
Your doctor must tell you about your medical condition and about what different treatments and pain management alternatives can do for you. Many treatments have “side effects.” Your doctor must offer you information about problems that a treatment is likely to cause. Often, more than one treatment might help – and people have different ideas about which is best. Your doctor can tell you which treatments are available, but your doctor can’t choose for you. You make that choice, depending on what is important to you.
Can other people help with my decisions?
Yes. Patients often ask relatives and close friends for help in making medical decisions. They can help you think about the choices you face. You can ask the doctors and nurses to talk with your relatives and friends, and they can ask the doctors and nurses questions for you.
Can I choose a relative or friend to make healthcare decisions for me?
Yes. You can tell your doctor that you want someone else to make healthcare decisions for you. Ask the doctor to note in your medical record the name of the person who will be your healthcare “surrogate.” The surrogate only makes decisions for you during treatment for your current illness or injury or, if you are in a medical facility, until you leave the facility.
What if I become too sick to make my own healthcare decisions?
If you haven’t named a surrogate, your doctor will probably ask your closest available relative or friend to help decide what is best for you. That works most of the time, but sometimes everyone doesn’t agree about what to do. That’s why it is helpful if you can say in advance what you want to happen if you can’t speak for yourself.
Do I have to wait until I am sick to express my wishes about health care?
No. In fact, it is better to choose before you are very sick or have to go into a hospital, nursing home, or other healthcare facility. You can use an Advance Health Care Directive to say who you want to speak for you and what kind of treatments you want.
These documents are called “advance” because you prepare one before healthcare decisions need to be made. They are called “directives” because you are directing them about what you want done. In California, the part of an advance directive you can use to appoint an agent to make healthcare decisions is called a Power of Attorney for Health Care. The part where you can express what you want done is called an Individual Health Care Instruction.
An advance directive is a document that puts your wishes about your health care in writing, and informs your family, doctor and others involved in your care of your wishes if you become unable to make decisions or communicate for yourself. In addition to having your wishes respected, filling out an advance directive takes some of the pressure and responsibility off the shoulders of loved ones; they don’t have to guess about what you would have wanted. Anyone 18 and older can make out an advance directive.
You may have heard the term living will. This is a written document that specifies what types of medical treatments are desired. More specific living wills may include information regarding someone’s feelings about treatments such as pain relief, antibiotics, hydration, feeding, and the use of ventilators or resuscitation.
An advance directive has three parts. In the first part you can name a person to be your agent (and alternates in case your agent is not available) to legally make health care decisions on your behalf. This person is called a Durable Power of Attorney for Health Care.
In the second part, as in a Living Will, you can detail the treatments you would and would not want, and under what circumstances—things like feeding tubes, ventilators, and what to do if your heart and breathing stop. In the third part you can address whether you want your body donated to science.
If you don’t want an advance directive, you will still get medical treatment.
Thinking It Over
Developing an advance directive should involve thinking about what you would want for yourself, and then talking those ideas over with people you trust. What would be your highest priority? It might be to be free of pain, or to not be on a ventilator (breathing machine), or to have everything done to keep you alive as long as possible.
Choosing An Agent
When you are choosing an agent, you should consider people over 18 years old who know you and you believe will honor and respect your values and wishes, even if your wishes are different from theirs. The agent must be willing to accept the responsibility, be geographically available, and have a strong enough personality to ask questions and stand up for you.
The agent you appoint may be a family member, a friend, or even your attorney. But it cannot be the owner or operator of a residential care facility where you live, or one of your health care providers, unless the person is related to you or is a co-worker.
The agent you name usually makes decision only after you lose the ability to make them yourself. But, if you wish, you can state in the advance directive that you want the agent to begin making decisions immediately.