Many patients coming through our office last year and this year will notice that we are asking periodically about whether they have advanced directives. Advanced directives consist of a living will and healthcare powers of attorney, also called a health care proxy.
A Living Will is a document in which a person specifies any healthcare preferences that they have in the event of catastrophic illness or accident that leaves them unable to voice their own preferences. It does not have anything to do with a legal will or a person’s finances. For example, a person might specify that he or she does or does not want to be on life-support (i.e. mechanical ventilation), have a feeding tube, receive CPR, or other heroic measures.
A healthcare proxy is a document that elects a substitute decision-maker for healthcare decisions. This document is only in effect if the person it references is unable to make his or her own decisions, such as because they are in a coma. A health care proxy has no voice if the patient it references can make his or her own decisions. An alternate health care proxy should be listed on the form in the event that the first person is unavailable. For example, many, many years ago I had as patients a married couple who were in the same automobile accident. Both of them were on mechanical ventilation in the intensive care unit. They had only appointed each other as healthcare proxies. There were no alternates listed. This made medical decision-making very difficult for the healthcare team.
When picking healthcare proxies, it is important to talk to your selections and make sure that they understand your wishes and feel that they can implement them. There are situations in which a spouse or close loved one is not the right person to appoint as a healthcare proxy. For example, if a husband tells a wife that despite her wishes, he will keep her on mechanical ventilation and put in a feeding tube if needed just to keep her alive even if there is no quality to that life and it is against her wishes, he is probably not the right person for her to choose if she feels strongly that she does not want these things.
A healthcare proxy can be anyone that is of adult age and is mentally competent. By law, a healthcare proxy can overrule the wishes of the patient as expressed in a living will, so the selection of these folks us very important.
The legal documents for North Carolina are available upon request at Hodges Family Practice, along with education about how they should be completed. The documents will need to be witnessed by two individuals not mentioned in the person's estate (legal financial will) and then notarized. They should be kept in an accessible place in the home as opposed to a bank safety deposit box, which does not allow for immediate and easy access. We at Hodges Family Practice would love to keep a copy on file in your chart for emergencies. Remember that advanced directives are not transferable across state lines at this time, so if you completed some in years past when you lived in a different state, they need to be redone on the recognized North Carolina forms.
Beth Hodges, MD