Advance Directives for Medical Decisions

The Living Will

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12/13/2014

Advance directives for medical decisions
Advance directives define your choices for end-of-life care and Living wills express your wishes and choices when you're not able to express them yourself. A living will is a written, legal document that provides instructions for the medical care that you want or do not want to be used to stay alive, as well as other decisions on your pain management, and if you want to donate your organs. These documents are so valuable in healthcare situations because they determine your wishes and what you value in life like the importance of being self-sufficient and independent. You can express what situations would make your life not worth living and what procedures you would want if they provided a cure.
Your healthcare provider or doctor can arrange for consultation and information about discussing your personal requests. There are many situations and decisions that should be addressed about potential end-of-life care and your doctor can provide information about these issues. Some situations in which a Living Will might apply and would be of benefit to those involved would be if you stated that you would like to be resuscitated by cardiopulmonary resuscitation (CPR) or by a defibrillator to shock you heart to start beating again. You can also have a provision for use of a ventilation so you can breathe and list for how long you should be connected on a ventilator for. Another issue to consider is if you need to be fed by a tube intravenously or through the stomach. Equally important is the need for Dialysis in case your kidneys fail to function and for how long you would prefer to receive this treatment. With this in mind, if antibiotics or other antiviral medicine should be use on infections or if you want them treated or just let them take their course. There are many types of procedures that can be given to keep you comfortable and manage any pain. A palliative care statement can allow for your treatment request and can include for you to die at home, provide for pain medication, and avoid for test and painful treatments. Under these conditions, you can specify if you want your organs to be donated for transplants and that you will only be kept on life support until they are removed. You can also state if you want your body donated to science but you should have planned this in advance and registered with a medical university for research.
The legal authority these documents provide for decision making by family and healthcare providers were made by instituting advance medical directives as a component of medical care in the United States in the past couple of decades of healthcare regulation. Advance directives were generated due to the prevalent apprehensions of patients experiencing undesired medical treatments and procedures in the attempt to save lives. For this purpose, advance medical directives and living wills contribute in a person's medical care and assist in making decisions in situations where they are unable to temporarily or permanently make a decision. By having a living will that has up to that time recognized the personal wishes and preferences that can alleviate the family's and physicians' enormous executive decision and lighten the burden at the same time. This will provide patient independence and dignity by preserving structured medical care based on the requests made without regard of mental or physical capacity. These advance directives are completed by a person with the decision-making capacity and only become effective when a person loses that capacity. While a person maintains ability to make decisions, they are the ultimate decision-maker rather than the advance directive or living will.
The advance directive is activated when the patient is not able to make their own healthcare decisions or is mentally incapacitated. A common situation where a living will can help with the decision making process is when a patient falls into a coma, or is in a continuing vegetative state, has severe brain trauma or injury, has a stroke that incapacitates, they are in advanced Alzheimer's disease or another type of dementia, and has a critical medical ailment affecting mental capacity. Advance directives not only help with decision-making in times of incapacity, but they can also simplify the choice made during cases of uncertainties while still able to decide. Sometimes, the decision to accept or decline a treatment or procedure may overcome a person decision and cast uncertainty on their judgment.
In conclusion, attaining medical advance directive documents is relatively easy and medical offices, hospitals, social workers, attorneys, and even post offices may have them. On the other hand, hospitals that receive Medical and Medicaid reimbursements are mandated to suggest these documents to their patients. When preparing advance directive for a living will, these documents can be done at any time during an adult person's lifetime. The preference can naturally change during their lifetime and these documents can also be amended and modified to reflect the changes. People do not need to have an advance directive or living will to have do not resuscitate (DNR) and do not intubate (DNI) orders. You can notify your doctor and tell him your decision or choice, which can be written as an order and added to your medical record. However, if you have a living will, ensure you inform the doctor and staff that you have a DNR or DNI order on file.

LIVING WILL: ADVANCE DIRECTIVE FOR HEALTH CARE
Date of Directive: 12-13-14
Name of person executing Directive:
Address of person executing Directive:
A Living Will, A Directive to Withhold or to Provide Treatment
1. I willfully and voluntarily make known my desire that my life shall not be prolonged artificially under the circumstances set forth below. This Directive shall be effective only if I am unable to communicate my instructions and:
a. I have an incurable or irreversible injury, disease, illness or condition, and a medical doctor who has examined me has certified:
1. That such injury, disease, illness or condition is terminal; and 2. That the application of artificial life-sustaining procedures would serve only to prolong artificially my life; and 3. That my death is imminent, whether or not artificial life-sustaining procedures are utilized.
OR
b. I have been diagnosed as being in a persistent vegetative state.
In such event, I direct that the following marked expression of my intent be followed and that I receive any medical treatment or care that may be required to keep me free of pain or distress.
Check one box and initial the line after such box: †
 I direct that all medical treatment, care, and procedures necessary to restore my health and sustain my life be provided to me. Nutrition and hydration, whether artificial or non-artificial, shall not be withheld or withdrawn from me if I would likely die primarily from malnutrition or dehydration rather than from my injury, disease, illness or condition.
OR
† I direct that all medical treatment, care and procedures, including artificial life-sustaining procedures, be withheld or withdrawn, except that nutrition and hydration, whether artificial or non-artificial shall not be withheld or withdrawn from me if, as a result, I would likely die primarily from malnutrition or dehydration rather than from my injury, disease, illness or condition, as follows:
(If none of the following boxes are checked and initialed, then both nutrition and hydration, of any nature, whether artificial or non-artificial, shall be administered.)
Check one box and initial the line after such box: †
A. Only hydration of any nature, whether artificial or nonartificial, shall be administered. †
B. Only nutrition, of any nature, whether artificial or nonartificial, shall be administered. †
C. Both nutrition and hydration, of any nature, whether artificial or non-artificial shall be administered.
OR † I direct that all medical treatment, care and procedures be withheld or withdrawn, including withdrawal of the administration of artificial nutrition and hydration.
2. If I have been diagnosed as pregnant, this Directive shall have no force during the course of my pregnancy.
3. I understand the full importance of this Directive and am mentally competent to make this Directive. No participant in the making of this Directive or in its being carried into effect shall be held responsible in any way for complying with my directions.
4. Check one box and initial the line after such box:
 I have discussed these decisions with my physician and have also completed a Physician Orders for Scope of Treatment (POST) form that contains directions that may be more specific than, but are compatible with, this Directive. I hereby approve of those orders and incorporate them herein as if fully set forth.
OR †
I have not completed a Physician Orders for Scope of Treatment (POST) form. If a POST form is later signed by my physician, then this living will shall be deemed modified to be compatible with the terms of the POST form.
DATE AND SIGNATURE OF PRINCIPAL
(You must date and sign this Living Will and Durable Power of Attorney for Health Care.)
I sign my name to this Statutory Form Living Will and Durable Power of Attorney for Health Care on the date set forth at the beginning of this Form at: (Signature) (City, State)

References:
Centers for Disease Control and Prevention, (2014). Advance care planning: Ensuring your wishes are known and honored if you are unable to speak for yourself. Retrieved from, http://www.cdc.gov/aging/pdf/advanced-care-planning-critical-issue-brief.pdf.
Mayo Foundation for Medical Education and Research, (2014). AskMayoExpert, Do not resuscitate (DNR) or do not intubate (DNI) order.
Farkas, Henry, (2014). "End-of-Life Decision Making." eMedicineHealth.com. Retrieved from, http://www.emedicinehealth.com/end-of-life_