Decide for Yourself, A Guide to Advance Health Care Directives

Decidefor YourselfA Guideto AdvanceHealth CareDirectives

Table of ContentsIntroduction.................................................................................. 1What is an advance health care directive?....................................... 1Who can make an advance health care directive?........................... 2Can a family member or friend make health care choicesfor me if I become incompetent and I have not nameda health care agent?........................................................................ 3Why should I name a health care agent when a family memberor friend can speak for me if I become incompetent?.................... 3How can my doctor help me make my advancehealth care directive?...................................................................... 4Who should I name as my health care agent?................................ 4What should I think about when I make my living will?............... 5Is there a form that I must use when I makemy advance health care directive?.................................................. 6How do I sign my advance health care directive?........................... 6Must I have my advance health care directive notarized?............... 6What should I do with my advance health care directiveonce it’s completed?....................................................................... 6What if I change my mind?........................................................... 7Do my doctors have to follow my living will and the requestsof my health care agent or health care representative?.................... 7Will my advance health care directive be followedin other states?............................................................................... 8Will my health care agent or representative paymy health care bills?...................................................................... 9How do I get more information on advance healthcare directives?............................................................................... 9This document may be reproduced in whole or in part onlywith the express written permission of The Hospital & Healthsystem Associationof Pennsylvania (members only) or the Pennsylvania Medical Society.© 2007 – Pennsylvania Medical Society, The Hospital & Healthsystem Association of Pennsylvania.

IntroductionThere may be times in your lifewhen you cannot make your ownhealth care choices. An advancehealth care directive helps you planfor your care in these situations. Bystating your wishes in advance, youcan have a voice in your care whenThis guide gives generalinformation about advancehealth care directives. It does notreplace medical or legal advicefrom a professional. You shouldtalk with your doctor about youradvance health care directive.Consult your attorney if you wantlegal advice.you cannot speak for yourself. You also can choose who mayspeak for you.Your advance health care directive can help comfort yourfamily and friends when you have a serious medical problem.By sharing your treatment wishes in a written document,you spare them from having to make tough decisionswithout knowing what you would want.Making an advance health care directive is important forall of us—not just for people who know that they will befacing end-of-life decisions in the near future. Anyone maylose their ability to make health care choices without warningdue to an unexpected illness or accident.What is an advance health care directive?There are two main types of advance health care directives:• In a living will, you write your specific wishes about lifesupport and other medical treatments. Instructions inyour living will take effect only when you cannot under-

stand, make, and communicateyour treatmentchoices (see definition ofincompetent) and youeither have an end-stagemedical condition or arepermanently unconscious.• In a health care powerof attorney, you name aperson who you trust tomake health care choicesfor you. This person isyour health care agent. Youcontrol what choices youragent may make, whenyour agent may make thosechoices, and how you wantyour agent to make yourchoices.Incompetent means that you cannotunderstand, make, and communicate aspecific health care choice, even whenyou are given help, such as an interpreter.You may be competent to make somehealth care choices, but incompetent tomake other ones. You also may becometemporarily incompetent and later regaincompetence.End-stage medical condition meansan advanced illness or other medicalcondition that cannot be cured or reversedand will result in your death, even if youreceive medical treatment.Permanently unconscious means thatyou are totally unconscious and thiscannot be reversed or made better. Whenyou are permanently unconscious, youcannot interact with or respond to peopleor things around you.You may make a combined directive that includes both aliving will and a health care power of attorney.Who can make an advance health caredirective?Any adult (18 years of age or older) of sound mind maymake an advance health care directive. A minor (less than18 years old) of sound mind also may make an advancehealth care directive if he or she has married, has graduatedfrom high school, or is legally free from control of parents(emancipated).

Can a family member or friend make healthcare choices for me if I become incompetentand I have not named a health care agent?A health care representative may make health care choicesfor you if you become incompetent and you have:• No living will with applicableinstructions,• No available health care agent,and• No legal guardian to make healthchoices for you.Pennsylvania law allows you tochoose your health care representativewhile you are of sound mind.You just need to put your choicein writing or tell your health careproviders in person.Health carerepresentative list:1. Spouse (unless one of youhas filed for divorce) andadult child from a differentrelationship2. Adult child3. Parent4. Adult brother or sister5. Adult grandchild6. Adult who is familiar withwhat you would wantIf you do not name a health care representative, Pennsylvaniahealth care providers generally must use someone froma list of family members and other persons close to you (inthe order listed in box).Why should I name a health care agent whena family member or friend can speak for me ifI become incompetent?It usually is better to name a health care agent in a healthcare power of attorney instead of relying on a health carerepresentative to speak for you. One important reason is

that by planning in advance, you increase the chance thatthe person who speaks for you will make the choices thatyou would have made.How can my doctor help me make myadvance health care directive?Talking to your doctor is an important first step. Your doctorcan:• Help you understand your medical conditions and thechoices that you may have to make about medical treatment,• Help you understand why there may be a time when youcannot make your own health care choices,• Describe common medical treatments that people needwhen seriously ill, such as “life-support,” and• Explain the benefits and burdens that you could expectfrom these treatments.Who should I name as my health care agent?You generally may name any adult (18 years of age or older)as your health care agent. Choose someone who:• Knows you well and can be trusted to honor your choices,• Is able to make difficult choices under stressful circumstances,• Is able to stand up for you to make sure that your choicesare honored as much as possible, and

• Is likely to be available, able, and willing to make healthcare decisions for you when you cannot speak for yourself.It is a good idea to name one or more alternate health careagents. There may be times when your first choice for ahealth care agent is unavailable, unable, or unwilling toserve. For example, your first choice may be away on vacationand unreachable or may also become too sick to makeyour decisions.What should I think about when I make myliving will?Think about how you would like to be cared for if you havean end-stage medical condition or are permanently unconscious.You may want to give specific instructions about:• Life-support and other treatment to keep you alive—Doyou want to receive highly technical treatments, tubefeeding (artificial nutrition andArtificial nutrition and hydrationmeans nutrition (food) and hydration(water) given to you by artificialor invasive means. It frequentlyis referred to as tube feedingbecause the solutions are givento you through a tube put in yournose, stomach, intestines, arteries,or veins.It is important that you specificallystate your wishes about tube feedingwhen you make your advance healthcare directive. Pennsylvania law hasprotections to make sure that tubefeeding is given when necessary topreserve your life unless it is clearthat you would not want it under thecircumstances.hydration), or other care thatyour doctor believes will onlydelay the time of your deathor keep you in a permanentlyunconscious state?• Pain control and other relief—Doyou want medicinesand other treatments to relieveyour pain or other severesymptoms, even if these willcause you to sleep more andperhaps make you less able tointeract with loved ones?

make sure that it is somewhere that your family or healthcare agent can get it if you are ill.Ask your doctors and other health care providers to put acopy of your advance health care directive in your medicalrecord. Take a copy with you if you are admitted to a hospital,nursing home, or other health care facility.Give a copy to your health care agent (including the peoplewho you name as alternate agents). Be sure to talk withthem about your instructions, preferences, and goals formedical treatment, even if you have stated them in youradvance health care directive.Give a copy to close family members and other people whoyou expect would want to help make medical decisions foryou if you are too sick to do so. You also may want to give acopy to your spiritual advisor (pastor, priest, or rabbi) andyour attorney.What if I change my mind?You should read your advance health care directive fromtime to time to make sure it still expresses your wishes. Youcan amend (change) your directive or revoke (cancel) yourdirective completely.Do my doctors have to follow my living willand the requests of my health care agent orhealth care representative?Your doctor and other health care providers generally musttreat instructions in your living will and the requests of yourhealth care agent as if they were personally made by you.

Will my health care agent or representativepay my health care bills?The choices of your health care agent or representative mayresult in you being billed for health insurance premiums, orhealth care costs that are not covered by your health insurance.You or your estate remain responsible for these costs.If you want to name someone to pay your bills from yourmoney and handle your other financial arrangements, youneed to make a financial power of attorney. This is somethingthat you may want to discuss with your attorney.How do I get more information on advancehealth care directives?For more information, including sample forms, additionalquestions and answers, and other resources, go to thePennsylvania Medical Society’s patient Web site atwww.myfamilywellness.org or The Hospital & HealthsystemAssociation of Pennsylvania Web site at www.careforpa.org.

777 East Park DrivePO Box 8820Harrisburg, PA 17105-8820(717) 558-7750www.pamedsoc.orgwww.myfamilywellness.org4750 Lindle RoadPO Box 8600Harrisburg, PA 17105-8600(717) 564-9200www.haponline.orgComplaints concerning non-compliance with the advance directive requirementsmay be filed with the Department of Health by calling 1-800-254-5164.© 2007 – Pennsylvania Medical Society, The Hospital & Healthsystem Association of Pennsylvania.