Advance Directives for Health Care FAQ
Why are they important?
Imagine that you are 40 years old and are involved in a motor vehicle accident leaving you permanently unconscious. Who will decide whether you are kept alive with tube feedings? Or what if you are in a hospital, terminally ill with cancer and are confused. Who will decide whether you should have CPR (cardiopulmonary resuscitation) if your heart suddenly stops? Or what if you have Alzheimer’s Disease and develop a serious infection as a patient in a nursing home. Who will decide whether or not you will be hospitalized and treated with antibiotics? People have the right to make their own health care decisions. If you become incapable of making health care decisions for yourself due to injury or illness, you can remain in charge of your health care, even after you can no longer make decisions for yourself, by completing an Advance Directive (AD). Advance Directives (AD) are legally binding written instructions which help people communicate their treatment choices when they are unable to make such decisions as well as designate a person to act on their behalf in making medical decisions.
How does a Living Will differ from an Advance Directive? What if I already have a Living Will? Do I need to create an Advance Directive?
Either form is honored. A “Living Will” is the term used prior to 2004 and is limited to decisions made if a person is diagnosed with a terminal or irreversible condition or illness. The more current form is referred to as an Advance Directive (AD). An AD instructs your doctor how you want to be treated allowing you to express your desires clearly and specifically if you are unconscious and cannot speak for yourself. You may also add other special instructions or limitations to your AD. Any Advance Directive form should include a determination of a Durable Power of Attorney for Health Care (DPOAHC) /Health Care Agent and instructions for physicians as to the preferred direction of treatment addressing when quality of life becomes unacceptable. If an individual cannot identify a DPOAHC/Agent, the directive portion of the document should be completed for purposes of identifying an appropriate direction of treatment.
What is a Durable Power of Attorney for Health Care (DPOA or DPOAHC) or Health Care Agent?
A Durable Power of Attorney for Health Care or a Health Care Agent is a a person you designate to make health care decisions for you if you are unable to make them for yourself. Your DPOAHC/Agent can make any health care decision that you could make if you were able. This individual receives specific instructions from you about the type of care you would want to receive. The naming of a DPOAHC/Agent allows your decision maker to respond to medical situations that you might not have anticipated and to make decisions for you with knowledge of your values and wishes.
I am a young person in good health. Do I really need to create a formal Advance Directive?
Advance Directives are for ALL adults, including mature minors and emancipated minors. You never know when an accident or serious illness will leave you incapable of making your own health care decisions.
Can I still make my own health care decisions once I have created an Advance Directive?
Yes. Your Advance Directive does not become effective until you are incapable of clearly expressing your own wishes. As long as you can do this, you have the right to make your own decisions.
Can any person create an Advance Directive?
Yes. Any adult (including a mature or emancipated minor) who has the capacity to make medical decisions can create an Advance Directive. Mentally challenged and developmentally delayed individuals can create an AD as long as the individual can articulate an understanding of the medical circumstances and the potential outcomes of the chosen treatment process.
What if my doctor or my family does not agree with my treatment choices or health care decisions?
Talk with your family and healthcare providers about your decisions, personal values, and beliefs. If others understand your choices and the reasons for them, there is less of a chance that they will challenge them later. If you have made your wishes known in an Advance Directive and a disagreement does occur, your doctor and your agent must respect your wishes. You have a right to refuse or consent to health care. If your doctor cannot comply with your wishes, he or she must transfer your care to another doctor. The consent or refusal of your DPOAHC/Agent is as meaningful and valid as your own. The wishes of other family members will not override your own clearly expressed choices or those made by your agent on your behalf as this written form is a legally binding document.
What if I change my mind about who I want to be my agent or about the kind of treatment I want?
You should review your Advance Directive periodically to make sure it reflects your current wishes. The best way to change your Advance Directive is to create a new one. The new Advance Directive will automatically cancel the old one. Be sure to notify all people who have copies of your Advance Directive that you completed a new one. Collect and destroy all copies of the old version.
If I decide to appoint a DPOAHC/Health Care Agent, how should I choose my Agent & alternate?
Choose someone who knows your values and wishes, and whom you trust to make decisions for you. Ask if they understand and agree to be your representative. This needs to be someone who is available if needed and who will decide matters the way you would decide. Name only one person each as your agent and your alternate.
What instructions should I give my agent concerning my health care?
You may give very general instructions and preferences, or be specific. Your agent needs to have directions from you about life-prolonging intervention, particularly medically administered food and water (tube feedings), cardiopulmonary resuscitation (CPR), the use of machines to help you breathe, and organ & tissue donation. Talk with your agents about your choices, personal values and beliefs. Make sure they know what is important to you. This information will help them make decisions you would make if you were able.
Are there any limitations on carrying out instructions in my directive if I am pregnant?
Yes. Instructions regarding withholding or withdrawing life-prolonging treatments likely would not be honored during the time you are pregnant.
Who should witness my signature on my Advance Directive? Does it require a notary?
Your two (2) witnesses must be competent adults who are not the DPOAHC/Agent and at least one (1) witness not related to you by blood or marriage or adoption. Choose persons who will not inherit any of your property. A notary can be used, but is not required. Exceptions to this are patients in a residential care facility.
Will another state honor my Advance Directive?
Laws differ from state to state, but in general, a patient’s expressed wishes are honored. No law or court has invalidated the concept of Advance Directives, and increasing numbers of statutes and court decisions support it.
What should I do with my Advance Directive after I sign it?
After your Advance Directive is signed, witnessed and/or notarized, give one copy each to your agent, your alternate agent, your doctor, and your local hospital. Keep the original document in a safe location where it can be easily found. Your safe deposit box is not the best place for your Advance Directive unless you are certain someone close to you has access if you become incapacitated. A photocopy of your Advance Directive is legally valid.
Where do I get Advance Directive documents and how do I get them scanned into my medical record?
You can request an Advance Directive document (The Five Wishes® format) from Admitting, Spiritual Care, or Social Work. Other formats can be obtained from alternative online sources or from an attorney. Spiritual Care and Social Work can assist with your questions regarding completion of the Five Wishes document. Once completed and signed, a copy of the document is presented to Admitting or Medical Records at any CHS facility. You will fill out an Advance Directive Registration Form. This form and your document will then be immediately scanned into your existing medical record. If there is no pre-existing medical record a new one will be created for this purpose.
You, your lawyer or your physician can also email/fax/or mail these forms to CHS. The email address is firstname.lastname@example.org. The fax number is 805-569-7442. The mailing address is CHS, PO Box 689, Santa Barbara, CA 93102 ATTN: H.I.M.