Between Two Worlds

Conventional wisdom suggests we should all go out and get living wills in the wake of the Terri Schiavo tragedy. Many (like me) assumed that “living wills” were the only kind of Advance Medical Directive you could sign thing you could sign to guide medical professionals in the event that you are unable to convey your wishes. In fact, though, there is another kind of directive, called a Durable Power of Attorney for Health Care Decisions (DPAHCD).

According to Carrie Gordon Earll, the DPAHCD is preferred over a Living Will for the following reasons:

The Living Will

• is a vague statement saying a physician may withhold or withdraw treatment if you are terminally ill
• is a piece of paper that medical professionals may ignore or misinterpret
• gives blanket authority to a doctor you may or may not know, a serious concern in these days of managed care
• generally exempts doctors from liability, regardless of a medical surrogate’s directions
• does not guarantee your wishes will be carried out
• presumes non-treatment, regardless of medical situation
• allows “treatment” to be defined by state law (In many states, medically assisted nutrition and hydration is considered medical treatment).

The DPAHCD, on the other hand:

• appoints a surrogate to make your medical decisions (applies in any crisis, regardless of prognosis)
• names a person who will be your advocate
• gives authority to a loved one who knows your wishes
• legally clarifies surrogate
• generally exempts doctors from liability if following directions from your surrogate
• may include an addendum outlining your specific wishes to provide guidance for your surrogate
• defers to surrogate and written wishes

Ms. Earll explains that, in accordance with the Patient Self Determination Act of 1990, health care facilities receiving federal funds are required to ask patients upon admission if they have or want to sign an Advance Medical Directive. But of course, it is best to consider and sign such a document before you need it. It is suggested that an addendum or a letter to your surrogate be added outlining your wishes in specific situations. A successor to your surrogate should be named, the directive should be updated in accordance with your current wishes, and a copy should be sent to your family, your physician, and your local doctor. An Advance Medical Directive can be obtained through an attorney, a stationary store, the state legislature, or a probate court. You don’t have to hire an attorney in order to sign it.

However, for those who are pro-life, anti-euthanasia, it is wise not to rely upon the language provided in a state statute. Instead, you should order a Protective Medical Decisions Document, created by the International Task Force on Euthanasia and Assisted Suicide. Ms. Earll explains:

This document, entitled the “Protective Medical Decisions Document” (PMDD), defines and prohibits euthanasia, as well as stating that “ordinary nursing and medical care and pain relief appropriate to your condition be provided.” The PMDD is a general Durable Power of Attorney for Health Care which allows the signer to name a trusted family member or friend to make medical decisions in the event the signer is incapacitated for any reason, not just terminal illness. The PMDD may be used in any state and may be attached to the advance directive form(s) approved by your state legislature.

For further explanation, and for a list of questions to consider when making end-of-life decisions, see Ms. Earll’s articles, Advance Medical Directives and Guideline for Making End-of-Life Decisions.

You can download an Advanced Directive here, prepared by the Center for Bioethics and Human Dignity. (HT: Joe Carter)