As a cognitively healthy adult, you have the right to be informed about the state of your health and make your own decisions about medical treatment. But, what happens if you become unable to voice your own decisions?
If a person becomes incapacitated, either temporarily or permanently, advance health care planning comes into play, said Erin Yelland, assistant professor in the School of Family Studies and Human Services at Kansas State University. Forming advance health care directives while being cognitively healthy allows a person to voice his or her wishes regarding future health care, in the event that person eventually becomes unable to do so.
Unfortunately, however, one in four U.S. adults has an advance health care directive in place, said Yelland, an adult development and aging extension specialist. Many people start the planning process as older adults, but this is something any person over the age of 18 should consider. At any point in life, tragedies – a car accident, farming accident or sudden serious disease – can happen.
The most common advance directives include a durable power of attorney for health care, living will and pre-hospital do not resuscitate directive. A packet with a copy of the Kansas statute forms for these directives, in addition to other important health care information, is available at local K-State Research and Extension offices or online at http://www.bookstore.ksre.ksu.edu/pubs/MF3280.pdf.
Durable power of attorney for health care
“In your advance health care directives, you can name someone who you would like to make decisions for you in the event that you are unable to speak for yourself,” Yelland said.
The person named to make medical decisions on another person’s behalf is called a “durable power of attorney for health care,” “medical power of attorney” or “health care agent.” This is not to be confused with naming a durable financial power of attorney, which Yelland said should be handled with the help of a lawyer.
Naming a durable power of attorney for health care is a much simpler process that requires completing an easy fill-in-the-blank form and getting signatures from two witnesses.
Importance of communication
A person’s named durable power of attorney for health care can make multiple decisions on his or her behalf, including what treatment to provide, who will administer the treatment and where the treatment should take place.
“For example, if you live in a small rural town in Kansas that perhaps doesn’t have specialists you would need at the local hospital, your durable power of attorney for health care has the ability to say, ‘I think this person needs to go to a larger city where they can receive more specialized care,’” Yelland said.
She added that it is important to choose a trustworthy person, perhaps a close friend or relative, and clearly communicate any medical wishes with that person.
“Make sure that person is willing to support you on your behalf,” Yelland said. “Your health care agent’s views do not necessarily have to align with your own, but it is important to ensure that they will carry out your wishes on your behalf.”
She noted that naming a health care agent could be difficult, especially for parents who have more than one child.
“Understand there might be hurt feelings if one child is the agent and other children are not,” Yelland said. “Having an open and honest conversation about why the decision was made and why you think that it’s best can be beneficial for the whole family.”
Talking to someone who has not yet completed their advance directives can be difficult, and starting the conversation can be the hardest part. Yelland said it might be beneficial to start the conversation by saying, “I need your help with something,” or “I need to start thinking about the future. Will you help me?”
“Start with talking about your own plans, and then spin it around to ask about their plans,” she said.
The living will
The living will, or an instruction list about what type of care a person would like to receive at the end of life, is also an important part of advance health care directives documentation. Unlike the durable power of attorney for health care form, the living will form does not appoint someone as a voice but rather explains in writing a person’s end-of-life wishes.
Specifically, the living will addresses a person’s wish to not accept life-sustaining procedures – being placed on a ventilator, or receiving artificial nutrition and hydration – if at least two physicians deem that person, in writing, as terminal.
“If you have specific wishes, and your wishes don’t exactly align with the Kansas statute fill-in-the-blank form, it’s recommended that you consult an attorney,” Yelland said.
She said it’s important to note that in pregnancy, the living will is no longer effective. There are instances when the mother is terminal but her baby can be saved by life-sustaining procedures.
Like the durable power of attorney for health care form, the living will is valid if completely filled out and witnessed by two people.
Updating and storing documentation
People should review their durable power of attorney for health care, living will and other advance health care directives documentation at least once a year to make sure it still aligns with their wishes, Yelland said. Also review the documents any time after a major life event, such as a marriage, divorce or separation.
To revoke the documentation, simply destroy it and complete new state statute forms. Keep note on who has copies of the forms, so that those copies are destroyed and replaced with new copies.
Make sure the durable power of attorney for health care, close family and friends, the local hospital and a primary care physician have copies of the forms. Consider keeping a copy in the glove box of the car, on the refrigerator, or somewhere open and accessible at home. The packet available through K-State Research and Extension also has a wallet card for people to carry that allows them to list places where their advance health care documentation is stored.
“Don’t just keep it in a safety deposit box at your bank,” Yelland said. “If something were to happen to you, there are few people, if anyone, who have access to that box and can get the documents for you. It’s important to note that copies are valid. So even if you keep an original in a safety deposit box, for example, if your son is your agent and he comes with a copy, that will be honored.”
People should also know that each state has its own statute forms, and it is not guaranteed that another state will accept the Kansas forms.
“If you move, it’s strongly recommended that you fill out that state’s forms,” she said. “If you spend a large amount of time in another state, if your children or grandchildren live in a different state and you spend a frequent amount of time there, it’s important that you fill out forms in that state as well, so that you can make sure your wishes will be honored no matter what state you’re in.”