Advance directives are legal documents by which individuals express their wishes in case they ever become incapable of making health care decisions for themselves. There are two types: the Living Will (also called a Directive to Physicians) and the Durable Power of Attorney for Health Care (DPAHC).
The laws governing these documents permit the withholding or withdrawal of life-sustaining treatment, including food and fluids, even when the intent is to directly cause death. Thus, the wrong kind of advance directive in the wrong hands can be a deadly combination.
Federal regulations require every health facility and program that receives Medicare and Medicaid funds to inform patients about advance directives. Many hospitals and nursing homes offer patients a directive to sign when they are being admitted and are probably under stress and distracted by other paperwork and questions. This is not an ideal circumstance for considering a legal document with life and death consequences. It is wise to arrive with your own carefully prepared directive in hand.
But first, you need to understand the significant differences between a Living Will and a Durable Power of Attorney for Health Care.
A Living Will (LW) is downright dangerous. It gives an attending physician, very likely someone you do not know, the power to make life and death decisions for you based on their interpretation of the directions in your LW. Real medical crises often involve complicated medical and ethical questions that can’t be foreseen when filling out a LW. Also, the directions you give in a LW, by law, must be followed. Therefore, you may tie the hands of a physician whose skills could restore you to health or save your life.
The directions in a Living Will are either so vague as to be useless or so specific as to be hazardous.
A Durable Power of Attorney for Health Care document is a better option. In a DPAHC you specifically name a trusted family member or friend (“agent”) to make decisions for you if you are unable, either temporarily or permanently, to do so for yourself. Your agent will endeavor to make decisions in accord with your personal values and wishes. Your agent will make medical decisions based on your actual condition and treatment options, not guesswork.
The wording of a DPAHC is critically important. Also, it must comply with the laws in your state. That is why Human Life Alliance recommends executing a state-specific Protective Medical Decisions Document (PMDD) formulated by the Patients Rights Council. The PMDD gives your “agent” the authority to act on your behalf and take legal action, if necessary, to ensure that your rights are protected. The PMDD clearly states that your “agent” does not have the authority to approve the direct and intentional ending of your life. This limitation not only protects you, but it also protects your “agent” from being subjected to pressure to authorize such actions.
A PMDD is absolutely essential for anyone who is 18 years or older. To be certain that a person you trust will be making medical decisions for you if you become incapacitated by an injury or illness, you must have specifically named that person in a legal document.
Filling out a PMDD takes only a few minutes - a few minutes that may mean the difference between life and death.
Recommended reading: Life, Life Support and Death: Principles, Guidelines, Policies and Procedures for Making Decisions to Protect and Preserve Life, 2nd Ed. 2005, American Life League, 1-540-659-4147.