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You Decide…
Complete Advance Directives For
End-Of-Life Care
In the tragic case of Terri Schiavo, a young
woman's parents and husband battled over her
care for years as she lay in a persistent vegetative
state. After repeated legal challenges, her feeding
tube was removed and she died in March 2005,
15 years after her collapse.
Regardless of where you fall on the ideological
divide, one thing is clear. If you want to make
decisions regarding your end-of-life care –
rather than have them made by your family,
guardian or the courts – you need to put your
requests in writing.
Completing Advance Directives
Advance directives are legal documents that allow
you to direct your health care if you are in a
coma, incapacitated or otherwise unable to participate
in your own health care decisions. There
are two main documents. A living will, which in
North Carolina is called the Declaration Of A
Desire For A Natural Death, allows you to specify
in writing the kinds of health care you want
under certain conditions. A health care proxy,
also known as health care agent or health care
power of attorney, allows you to name a person or
persons you trust to make health care decisions
for you when you cannot.
You can change or revoke your living will and/or
health care power of attorney at any time. Your
advance directives go into effect only if you are
seriously ill or injured and cannot communicate.
Six Steps To Take
- Consider the types of health care you want
under specific circumstances. For example, do
you want antibiotics to try to fight infection
regardless of the chance of re-infection? Do you
want life-prolonging treatment only if there is a
good chance of complete recovery, or would you
accept a limited level of recovery? What about a
ventilator (artificial breathing), artificial hydration
and feeding, cardiopulmonary resuscitation and
dialysis? Under what circumstances would you
accept or not accept these treatments?
- Choose the right person or persons to be your
health care power of attorney. The most important
question to ask yourself is "Do I trust this person
to make a decision for me based on what I would
want for myself, not what he/she would want for
me?" Your health care power of attorney can be
anyone; a family member or a friend. Appoint
a trusted person who is strong enough to be an
effective advocate for you.
- Discuss your wishes with the person or persons
you plan to name as your health care power of
attorney, as well as family members and close
friends. This is the most difficult and the most
important step in the entire process. Take your
time with this one. It is important because you
cannot anticipate every possibility in your living
will, so some decisions may have to be made based
on your spoken, rather than written, words. These
are the people who will be acting on your behalf
in a crisis situation, so it is crucial that they hear
from your lips what you wish for your care. Tell
them your thoughts, your concerns and your
choices. Don't assume that they "just know."
- Complete the forms according to the instructions.
In North Carolina, the forms should be
signed and dated in front of a notary public who
is not also your health care proxy, or in front of
two witnesses, at least one of whom is not also your
health care proxy.
- Keep a master copy of your advance directives in
a secure, accessible place at home. Also give copies
to your health care power of attorney, family members,
primary physician and specialty physicians.
- Review your directives each year or whenever
your health situation or philosophical outlook
changes and revise them as needed.
Note that most states will honor advance directives
completed in another state. However, they may be
interpreted differently. If you live part-time in one
state and part-time in another, be on the safe side
and have documents from both states. Keep in
mind that no state will honor a request that is illegal
under its laws (for example, assisted suicide),
regardless of whether it is legal elsewhere.
Where To Get Forms
You can obtain free advance directives forms
from CarePartners Health Services by calling
Jana Childress at (828) 277-4800 or e-mailing
jchildress@carepartners.org. You can also search online
for state-specific forms, but the site may request
personal information and charge a fee. If you find
forms available online, make sure that they meet
the statutory requirements for North Carolina
so that they will be solid legal documents.
Know that an attorney is not required for the
North Carolina Healthcare Power Of Attorney
and the Declaration Of A Desire For A Natural
Death (Living Will).
Geriatric Care Management can help you complete advance directives forms. See "A Nurse In Your Pocket" to learn more.
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