Marcus Daly Memorial Hospital: Advanced Directives.

Advance Directives – Why You Need One

Anna Westcott, MDMH Medical Social Services Department Head

What if an illness or accident leaves you in a coma? Would you want to have your life prolonged by any means, 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? Someday, you may become too sick to make your own decisions about your medical care. If questions arose about the type of medical treatment you would or wouldn’t want, an advance directive would guide your physician and family to make the decisions for your medical care based on your wishes. If you have not given any instructions, no one will know what you would have decided.

Montana and Federal Law gives every competent adult, 18 years or older, the right to make their own health care decisions, including the right to decide what medical care or treatment to accept, refuse or discontinue. "Competent" means you understand your condition and the results your decision may have. You also have the right to be told about your illness in terms you can understand, the nature of the proposed treatment, the risk of refusing treatments, and any alternative treatment that may be an option for your care. As long as you are competent, you are the only person who can decide what medical treatment you want and do not want to receive.

An advance medical directive is a statement of your choices for future health care. It can give instructions on your choices of medical treatment, and/or name someone to make those choices for you if you are unable to make these decisions yourself. It is called an “advance” directive, because you state your wishes before serious illness or injury makes you unable to express yourself. Many people have strong feelings about the kind of medical care they would like to receive or refuse in certain circumstances. An advance directive allows you to clearly state your feelings. Advance directives need to be shared with family members, physicians, other health care providers, clergy and friends as appropriate. All hospitals and skilled nursing facilities that accept Medicare and Medicaid are required by federal law to inform their patients about advance directives.

It is important to remember that advance directives only take effect when you can no longer make your own health care decisions. As long as you can give informed consent, your doctor and other health care providers will rely on you to make your own health care decisions. Informed consent means that you are able to understand the nature, extent and consequences of proposed medical treatment that you understand the risks and benefits of these treatments and you are able to communicate that understanding.

Montana law recognizes two types of advance directives.

1. A living will is a document, which tells your doctor or other health care providers whether or not you want life-sustaining treatments or procedures if you have a terminal or irreversible condition and a short time to live. It is called a “living will” because it takes effect while you are still alive. A Montana living will goes into effect when; your doctor has a copy of the document, your doctor has concluded that you can no longer make decisions for yourself and your doctor has determined that you have a terminal condition with a limited time to live.

2. A durable power of attorney allows you to name anyone at least eighteen years old to be your representative and make health care decisions for you. You can pick a family member, friend or any other person you trust, but be sure the person you choose is willing to serve. A durable power can be used to accept or refuse any treatment. Your representative has the responsibility to act in your best interest in making decisions about your health care. A durable power goes into effect only when you are not able to make decisions for yourself.

Either choice is a valuable tool for you, your family and your doctor.

Before writing down your health care directives, you should talk with those people closest to you and who are concerned about your care, your values and wishes about health care. Discuss these instructions with your family, doctor, friends and other appropriate people such as clergy or your attorney. You can also talk with any of the social workers associated with MDMH; Anna Westcott, Director of Medical Social Services, Phyllis Johnson, Home Health and Cathy Palmer in Hospice. All are Certified Advance Care Planning Facilitators and can assist you. These are the individuals who will be involved and affected with your health care when you are unable to make your own decisions.

Treatment decisions are difficult. We encourage you to think about your wishes in advance, discuss your options with your family, friends, and health care professionals, and make plans for your future health care needs.

Advance Directive Terminology:

Advance Directive:
A legal document that provides direction for your health care if you are not able to speak for yourself or make decisions. Can include power of attorney for health care, living will, comfort one, and organ donation.

Living Will:
Your directions to health care providers for end-of-life treatment you do and do not want if you are terminally ill, cannot speak or make decisions for yourself and are near death.

Power of Attorney:
A document appointing another person to make financial or business decisions. A power of attorney can be specially prepared so that it is valid if you ever become incapacitated. This is known as a durable power of attorney.

Durable Power of Attorney for Health Care:
A document appointing another person you choose as your Representative (agent) to make all health care decisions for you at any point in your life if you cannot speak or make your own decisions.

Representative:
A person appointed in a power of attorney for health care to make decisions for you only if you cannot communicate or make decisions for yourself. Also called an agent, surrogate, or proxy.

Will:
A document that states how you wish your possessions to be disposed of after your death.

Comfort One:
An identification designed for the person who is not in the hospital so that first responders will know that you do not want to be resuscitated. Enrollment is limited to those who have a terminal illness or those whose physician has ordered, “do not resuscitate” status.

Organ Donation:
A document provided by the deceased as consent for the donation of specific organs and/or tissue. The document may be a driver’s license, donor card or indication in an Organ Procurement Organization approved registry.