Planning for long term illness and incapacity is something that many would prefer to put off. While contemplating major illness isn’t always the most pleasant task, it is one of the best steps taken for the benefit of families and loved one. Making your wishes known in advance will lighten the burdens on your family in a time of need.
Important terms are:
- Principal/Patient – The person who has granted authority to another to make health care decisions on their behalf in a power of attorney.
- Agent – The person designated to make health care decisions on behalf of the principal.
- Primary Physician – The doctor designated by the patient to have primary responsibility for the patients care or a doctor who undertakes responsibility if the doctor designated refuses to act or one has not been designated.
- Surrogate – A person other than the patients agent or conservator that is authorized by law to make health care decisions.
- PHAC – Power of attorney for health care is a document designating an agent to make health care decisions for the principal.
- Health Care Decision – The authority to make decisions for a patient including:
- the selection and discharge of providers and institutions
- the approval or disapproval of tests, surgical procedures and medication programs
- directions to provide, withhold or withdraw artificial nutrition, hydration and all other forms of health care
Advance planning for health care decision making has increased with the enactment of many laws and court cases establishing the right to make such decisions, and putting in place the formal requirements to evidence such planning. Most importantly was the enactment of the Health Care Decisions Law in 1999 which authorizes a competent adult to make oral or written instructions that give directions for health care decisions or to appoint an agent under a power of attorney to make health care decisions on their behalf, or both. Planning for health care decisions can take many forms some of which are as follows:
- Advance Health Care Directive – The advance health care directive is in reality two documents combined into one. In this document you can express your individual desires regarding health care decisions for future needs and if you so choose a power of attorney can be added to give another person, the agent, the authority to make the health care decisions if you are unable to do so. The advance health care directive is the most widely used option. The advance health care directive can also be used to:
- address organ donation
- give special instructions or other wishes regarding care
- designate primary physicians
- provide burial or cremation instructions
- The California Medical Association Advance Health Directive – Similar to the the statutory health care directive, it is the proprietary form prepared by and purchased from the California Medical Association. The idea is the same in that the you makes decisions about future health care in advance and can also appoint an agent to make decisions on your behalf.
- Surrogate – A patient who is an adult may designate another adult as their surrogate to make health care decisions by personally informing the supervising health care provider if the designation is immediately entered into the patients record. Unless the patient states a shorter period then the surrogate designation is good for the duration of the illness/treatment/hospital stay or 60 days, whichever is shorter. While the use of a surrogate is not the best planning technique it provides an acceptable alternative if the patient failed to sign an advance directive.
- Power of Attorney for Health Care – This method of planning relies solely on appointing an agent to make decisions on your behalf and eliminates the added benefits of including provisions regarding your own wishes and desires. By including your own wishes and desires you make difficult choices somewhat easier on the agent and thus the advance health care directive would be a better choice.
- Conservatorship – A conservatorship is a court supervised process wherein one person is authorized to make decisions for you. Due to the expense, time involved and process the conservatorship is not the best choice for health care planning and would only be used in those circumstances where you failed to undertake any other planning prior to the need for health care.
- Request Regarding Resuscitative Matters – A request regarding resuscitation or DNR (do not resuscitate), is an instruction that allows a patient to give directions to pre hospital emergency help on a form prepared by the California Emergency Medical Services Authority. Should you desire a DNR instruction in the event you stop breathing or your heart stops beating the form can be completed and signed by your doctor and then filed with the authority directing a health care provider to forgo resuscitative measures. The form must be signed by your physician to verify your consent is informed consent. A medic alert bracelet with the terms DNR or DO NOT RESUSCITATE-EMS can be purchased to inform EMS personnel of your wishes. Typically, the DNR is used in patients who have a terminal illness and have voluntary elected to forgo resuscitation.
Planning for health care decisions is an important step that not only ensures your wishes are carried out but provides aid to your loved ones when tough decisions have to be made. By taking advantage of the options provided a small amount of thought early on can provide a significant amount of certainty in the future.