During emergencies, paramedics are often being called to a home where most people expect extraordinary procedures utilized at this time of crises. But this may not always apply in every situation.
As long as an individual is competent, he or she can make decisions whether to have treatment provided to them or discontinued, so there will be no further attempt to give them life support and other related medical treatment. In this case, a competent individual can make decisions regarding their health care relatively simple and easy. However, when the competency falls on a gray area, it will be tested to help determine whether the patient understands the nature of their illness and the consequences of a proposed treatment or lack thereof would have on them.
In Massachusetts, there is another person, a Health Care Proxy, to substitute a patient in making decisions regarding end of life and ongoing healthcare treatment.
Unfortunately, medical facilities do not provide for a so-called Do Not Resuscitate Order (DNR) as their standard form. Hence, many individuals have to indicate in their prepared documents the language to allow the agent under the Health Proxy to make decisions for all medical treatments covering the end of life and possible DNR.
In case there is no Health Care Proxy, there will be a guardian to be designated by the Probate Court to not only decide on the ongoing care for the patient but also to assess approval on extraordinary treatment or withdrawal of that treatment.
The enactment of the Uniform Probate Code of 2009 protects an incapacitated person's rights by initiating various protections or hurdles that must be done before a decision is made regarding their health care especially on an end of life situations. The process of Health Care Proxy will be more drawn out as a result of this.
A contest regarding who should serve as the Guardian may complicate all the issues as to whether or not the person's end of life decisions are being carried out in a manner that is right for them and as may have desired.
Normally, DNR Order is being executed by a person and is also signed off as accepted by that individual's physician which makes it a separate and distinct issue relative to the decision making process.
When called at home, paramedics must do all actions critically needed to preserve the life of a patient, but they are protected from the potential liability by a DNR Order, which provides them the right to withhold life-sustaining measures.
Creating advance directives
Each state has different forms and requirements in making legal documents. Hence, advance directives have to be in writing. A form may need to be signed by a witness or notarized depending on which state you live. It is generally not necessary, but you may seek assistance from a lawyer to help you with the process.
There are websites of various organizations that provide links to state-specific forms. Some of them are AARP, the American Bar Association, and the National Hospice and Palliative Care Organization.
Ask help from your doctor and your health care agent to review your advance directives to ensure that the forms have been filled out correctly. Once you completed your documents, do the following:
Secure all the original documents in a safe and accessible place.
Provide a copy to your doctor.
Provide a copy to your health care agent and any alternate agents.
Keep a file of who has your advance directives.
Discuss your advance directives and health care wishes to your family members and other important people in your life. By doing this, your family members will have a clear understanding of your wishes. This will help them avoid conflict and feelings of guilt.
Secure a card in your wallet that has the necessary information such as your advance directives and your health care agent. It should also indicate how a copy of your directives can be found.
Always bring a copy with you when you are traveling.
Reviewing and changing advance directives
You have the option to change your directives at any time. You will have to create a new form, distribute new copies, and destroy all old copies if you wish to make changes. Specific requirements in changing directives may also vary by state.
Changes have to be discussed with your primary care doctor and make sure your medical file is updated with the new directives. It must also be added to your medical charts in a hospital or nursing home. Also, have a conversation with your health care agent, family, and friends about the changes you have made.
You may consider the following situations in reviewing and creating new directives:
New diagnosis. It can make changes in your living will if there will be a diagnosis of a terminal disease or illness that will significantly alter your life. You should have a discussion with your doctor about the kind of treatment and care decisions to be made during the expected course of the disease.
Change of marital status. You may need to select a new health care agent when you marry, divorce, become separated, or are widowed.
A span of 10 years. Review your directives from time to time to make sure they align with your current values and wishes. Your perspective about end-of-life care may change over time.
