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Advance Directives

What if an illness or an accident leaves you in a coma? Would you want to have your life prolonged by any means necessary, or would you want to have some treatments withheld to allow a natural death? What if you are dying from a painful terminal illness? Would you want to receive medical procedures to prolong your life?

Advance Directives

What if an illness or an accident leaves you in a coma? Would you want to have your life prolonged by any means necessary, or would you want to have some treatments withheld to allow a natural death? What if you are dying from a painful terminal illness? Would you want to receive medical procedures to prolong your life?

An advance directive allows you to give instructions to your health care providers and your family on these topics. You can give them instructions about the types of treatments you want or don't want to receive if you become incapacitated. Usually, directives will only go into effect in the event that you can't make and communicate your own health care decisions. Up until then, you can continue to give directions to your health care provider even though you have an advance directive.

Hospitals and other health care providers are required under the federal Patient Self Determination Act to give patients information about their rights to make their own health care decisions. That includes the right to accept or refuse medical treatment. If you have executed a Living Will, Health Care Power of Attorney, or Advance Health Care Directive, your health care provider may ask you for a copy.

Advance Directive Types

The term advance directive can describe a variety of documents. Living Will and Health Care Power of Attorney documents are types of advance directives. Some states also have a document specifically called an Advance Health Care Directive. So, the term advance directive may be used to refer to any of these specific documents or all of them in general.

States differ widely on what types of advance directives they officially recognize. Some states also require that you use a specific form for the format and content of your advance directive. If you have specific questions, contact an attorney who is familiar with your state statutes regarding advance directives.
 

Living Wills

A Living Will allows you to state whether you want your life prolonged if you will soon die from a terminal illness or if you're permanently unconscious. In general, a Living Will indicates whether you want certain treatments withheld or withdrawn if they are only prolonging the dying process or if there is no hope of recovery.

As a general rule, Living Wills only go into effect if you're no longer able to make your own health care decisions. For example, if you suffer serious brain damage in a car accident or suffer an incapacitating stroke, you may be permanently unconscious and unable to communicate with your doctor. In this case, a Living Will lets your physician know your wishes concerning certain medical procedures.

Health Care Power of Attorney

Agent) to make health care decisions for you if you are unable to do so. The HCPOA is more flexible than a Living Will and can cover any health care decision, even if you are not terminally ill or permanently unconscious. A HCPOA can apply in cases of temporary unconsciousness or in case of diseases like Alzheimer's that affect decision-making. Like a Living Will, HCPOA's often allow you to state your wishes about certain medical procedures. Also as with the Living Will, a HCPOA generally only goes into effect when you are no longer able to make your own health care decisions.

Advance Health Care Directive

An Advance Health Care Directive combines the features of a Living Will and a Health Care Power of Attorney along with some other options. Some states have a specific advance directive form.

Choosing an Agent

Choosing an Agent for your Advance Directive could be one of the most important decisions you ever make. Unless you state otherwise in your directive, your Agent generally has the same authority to make decisions about your health care as you would. Since this person will be acting on your behalf if you become unconscious or unable to make health care decisions, this should obviously be someone you know and trust thoroughly. Your Agent should also know you very well--well enough to be able to make the same kinds of decisions you would. And he or she should be someone who cares deeply about your welfare. People often choose their spouse or other close family member to be their Agent.

You can limit your Agent's authority if you choose to do so. For example, you could specify that your Agent will not have authority to override your desire not to be put on life support equipment.

You should make sure the person you choose is willing to be your Agent. Discuss your wishes and values with him or her in advance so he or she can make the right decisions for you. Your Agent should be an adult and cannot be your health care provider (unless that person is a family member). It is also a good idea to designate an alternate Agent in case your Agent is not able to act as your Agent for any reason.

Finalizing the Directive

Once you've completed an advance directive, there are a few final steps you should take to make it effective:

    Discuss your advance directive with your doctor before you sign it. Make sure you are both comfortable with what it says. He or she may suggest something you hadn't thought of that you might decide to include.

    Comply with your state's signature and witness requirements. States have various requirements about who can be a witness, how many witnesses are needed, and if the directive must be notarized.

    Provide copies of the signed directive to: 1) your doctor and hospital; 2) your Agent if one is named; 3) family members and; 4) other significant people in your life.

Organ Donation

Have you considered donating your organs after death for transplantation or research? Unfortunately, many people fail to consider this question before they die and members of their family are left to make the decision for them. Since organ demand far exceeds supply, there are federal and state laws designed to increase donations. For instance, many states require hospitals to ask if patients have completed or would like to complete a donor form.

Organ donations are often referred to as "anatomical gifts." All fifty states have passed some version of the Uniform Anatomical Gift Act. This act allows a person to make a gift of organs and tissues during his or her lifetime with the gift to take effect upon death. Family members may also donate organs and tissues of a deceased relative if there is no indication the deceased was opposed to such a donation. Therefore, it is important to document your wishes concerning organ donation.

Documenting your Donation

You can express your desire to be an organ donor in a variety of documents. This may be a donor card you carry with you, an indication on your driver's license, or another document. Methods vary from state to state. Some states require completion of a specific form. To find out the best way to make your wishes known in your state, contact a local hospital, your health care provider, or your state's organ procurement organization. If you have specific questions about your state's requirements, you may want to contact a lawyer.

Many states make it easy to indicate your donor status by including this with your driver's license application/renewal. If you elect to be a donor, the information may be printed right on your driver's license.

Organ donations can also be indicated in a will and in advance directives. Indicating your desire to donate organs only in a will is not recommended, though. Such instructions might not be noticed in time to allow organs or tissues to be donated.

Regardless of your state's requirements, it's important that your family and loved ones know of your desire to donate your organs. Planning for such a possibility in advance and making your decision known increases the likelihood of your wishes being followed upon your death.

It's also a good idea to provide a copy of your organ donor documentation to your health care provider and hospital to be kept with your medical records.

Use of Organs

The Uniform Anatomical Gift Act allows for organs, tissues, or parts to be used for transplantation, therapy, research, and medical education. Organs and tissues can't always be used for all purposes, though. Some organs or tissues may not be used if it would interfere with an autopsy or another investigation. Also, if a donor suffers from particular diseases or dies under certain circumstances, his organs and tissues may not be suitable. Make sure (1) that they can accept the donation and (2) that you take the necessary steps for a successful donation. They should be able to help you document your donation properly.

If you don't specify a recipient or if the recipient you specify cannot accept the donation, the law generally provides that the donation can be transferred to an appropriate person or institution. There is a national system to allocate organs to individuals who need them for transplantation. Factors such as urgency of need, closeness of biological match, and geographic proximity help determine who gets the organs.

Donations by Others

Family members can generally decide to donate the organs of a deceased relative if there is no indication the deceased was opposed to such a donation. This decision usually falls first to the deceased's spouse, then to adult children, parents, adult siblings, and guardian. Some states give an attorney in fact under a health care power of attorney document authority to make organ donation decisions also. It is common for health care providers to ask family members for consent before removing organs, even if the deceased had completed a donor form.

You should discuss your wishes with your family and carry any completed organ donation form in your wallet or purse. Doing so may make your family's decision easier at a painful time and will increase the likelihood that family members will honor your wishes upon your death.

Medical Procedures

Nearly all states legally define death as either the irreversible stopping of all functions of the entire brain (brain death) or the irreversible stopping of circulatory and respiratory functions. Trauma to the head, bleeding into the brain, and lack of oxygen to the brain are some of the causes of brain death.

Organs such as the heart, lungs, and pancreas can be used for transplantation only if they are removed from a person whose body is maintained on life support systems after they are declared brain dead. The artificial life support is necessary to maintain an adequate blood supply to the organs so they are suitable for transplantation.

Most people don't suffer brain death and therefore their organs, such as their heart and lungs, cannot be used for transplants. However, some of their organs, tissues, or parts may still be useful. Such tissues as the cornea, bone, and skin don't need to come from a person whose body is artificially maintained on life support. However, all organs or tissues must be removed within a relatively short time after death.

Organs are removed after death in a way that minimizes visible signs of the removal. Unless other arrangements have been made, the body of a donor is typically available for funeral and burial arrangements after organs and tissues are removed.

Medical Screening

Donated organs and tissues are screened for infectious diseases such as hepatitis and HIV/AIDS. If an HIV test is positive, the deceased donor's family could possibly be informed of the results.

It is a crime in some states to try to donate organs or tissues if you know you are HIV positive and that the virus may be transmitted by a donation. If an HIV positive individual wants to donate organs or tissues for purposes such as research and education, specific arrangements should be made for such a donation with a medical research or educational facility.

Minors as Donors

Some states allow a minor to complete an organ donation form. The signature of a parent or guardian is usually required.

Even in states where state law does not provide that minors can donate organs and tissues, minors are encouraged to complete an organ donation form if they have opinion about the donation of their organs. A completed form indicates the wishes of a minor and may assist a parent or legal guardian in making a donation decision at a later time.

Revoking your Decision

Organ donation documents may generally be revoked in any of the following ways:

    A signed statement or document indicating revocation.

    An oral statement made in the presence of two people.

    Any communication to a physician during a terminal illness or injury.

    Delivery of a signed revocation to a designated recipient.

If a previous donation is contained in a will, you may revoke the donation by amending the will. The four options above can also revoke a donation made in a will.

It is important that anyone who had previously received a copy your donation form or who knew of your plans to donate organs be notified that your wishes have changed. Here are some ways to make sure your revocation is honored:

    If you have a copy of the now-revoked donor form, destroy it.

    If you previously had sent copies of the now-revoked donor form to other parties, such as a designated recipient, send them a copy of the revocation and any new forms.

    Communicate your revocations and your current wishes concerning organ donation to your family. Family members frequently are involved in organ donation decisions, so is important that they are aware of the existence of completed donor forms and of your wishes.

If you want to revoke or amend a donation made on your driver's license, you should follow the instructions provided at the time of the donation. If you have any doubts about the status of a driver's license donation, contact the state officials responsible for the administration of drivers' licenses or donor forms. At a minimum, carry any revocation documents with the license or identification card so that the revocation will be found.

Refusing to Donate Organs

You have the right to refuse to donate your organs. The Uniform Anatomical Gift Act allows you to document a refusal to donate organs. Even states that don't expressly address "refusal to donate" documents state that a person's wishes NOT to be an organ donor are to be honored at the time of his or her death.

If you don't want to be an organ donor for any reason, you should document your refusal to donate. A documented refusal may help your family members make a donation decision that is consistent with your wishes. If you have specific questions about refusing to be an organ donor, you should contact a lawyer.

Author’s note: The intent of this information provided by longtermcare.termlifeamerica.com is to inform and motivate the general public into action. One should consider only a qualified practicing legal individual or entity, in the state in which you reside, when making decisions on Living Wills.


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