Durable Power Of Attorney For Healthcare Decisions

WHAT YOU SHOULD KNOW:

A durable power of attorney for healthcare (DPAHC) is also called an advance directive. It allows another person to make healthcare decisions on your behalf. This person is called a healthcare agent. Your healthcare agent speaks for you if you are too sick or injured to make your wishes known. Healthcare agents are often family members or close friends. You must trust your healthcare agent to understand the care you want and to respect your wishes. Most states have legal forms to show your choice for a healthcare agent. Work with your caregivers, family, and agent to create a form that reflects your wishes and beliefs.

INSTRUCTIONS:

When a DPAHC takes effect:

Your DPAHC takes effect when you cannot make your own medical decisions. Depending on your state's laws, 1 or 2 doctors must decide that you can no longer make medical decisions. You may not be able to communicate what you want. You may not understand the choices that need to be made about your medical care and the effects of the choices. You may be able to communicate, but your ability to make good decisions has changed. You are not able to understand the choices that need to be made about your medical care. You are also not able to understand the effects of the choices that need to be made.

What a DPAHC does:

If you are in the hospital, you or your family will be asked if you have any advance directives, such as a DPAHC. If you have do not, your caregivers may give you treatments you do not want. You could live for months or years with these treatments, but not be conscious or aware. If you have a DPAHC, your agent will tell your caregivers what treatments you want to have or not have.

Types of decisions you can have your agent make for you:

Your agent can get information from any of your caregivers to help make decisions about your treatment. Your agent can talk about treatments with your caregivers and ask for second opinions. Your agent can transfer your care to another caregiver or healthcare facility, such as a hospital or a skilled nursing home. Your agent makes decisions based on the information you put in your DPAHC. If your agent is not sure of your wishes, your agent will do what he thinks is best for you.

  • Medical care: You can have your agent make decisions to start, stop, or refuse any of the following on your behalf:

    • Antibiotic (germ-killing) medicines

    • Chemotherapy or radiation therapy to treat conditions such as cancer

    • Diagnostic (finding) tests and invasive or painful procedures

    • Dialysis to remove wastes from your blood

    • IVs to give you liquids or tubes to give you food

    • Major surgery

    • Resuscitation (restarting your heart and breathing)

    • Ventilation (a machine breathes for you)

  • End-of-life decisions: At the end of your life, your agent can carry out your last wishes about the following:

    • Autopsy: You can decide to have caregivers perform an autopsy (exam to find cause of death).

    • Donation: You can decide to donate your organs or tissues for transplant. You can also decide to donate your body for research.

    • Funeral and burial: You can decide how you want your funeral planned. You can also decide if you want to be buried or cremated.

How to choose a healthcare agent:

Healthcare agents are often family members or close friends. You must trust your healthcare agent to understand the care you want and to respect your wishes. Choose an agent you trust to follow your wishes, even if your wishes differ from his. Your agent must be at least 18 years old. He should be willing to stand up for what you want. Try to choose someone who lives nearby and will be around for a long time. Most states do not allow your doctor or other caregivers to be your healthcare agent, unless they are related to you.

Where to get a DPAHC form:

Your hospital, caregivers, and other healthcare providers should have the forms or worksheets that are used for your state. Each state has rules for DPAHCs and other advanced directives. Most states allow advanced directives prepared in one state to be used in another state. You may still want to create DPAHCs for more than one state if you travel often or spend time in another state.

How to create a DPAHC:

  • Choose a healthcare agent and decide if you want to limit the agent's decisions. Make sure your agent knows your choice and agrees to help you. Write down any limits you want on the healthcare decisions that your agent can make.

  • Write down the treatments you want and do not want. Ask your caregivers to explain any treatments you do not understand before you make decisions about them. It may help to list the treatments you always want or never want. You may want some treatments only when there is a good chance that you will get better. For example, you may want a feeding tube while you recover from surgery. You may not want a feeding tube if you have been in a coma for 6 months or you have a long-term brain injury. You can start treatment and then stop if treatment is not working. You may want to refuse or stop treatments that prolong life but cause constant or severe pain. You may be willing to have pain, if treatment allows you to live longer.

  • Write down your wishes about other decisions you want your agent to be able to make. You may want a religious or spiritual leader with you to say prayers or blessings. You may want to be at home or in a hospice if you can. If you want to donate your body or organs, write this on your form. You may want your funeral or burial planned a certain way.

  • Talk with your family and caregivers about your wishes. They will have questions for you. These questions may help you better prepare your DPAHC. Your caregiver may not agree with your wishes. If this happens, you will need to find another caregiver to help you.

Legal requirements for signatures on a DPAHC:

You do not need a lawyer to write a DPAHC, but it must follow the rules of your state. The legal requirements may include the following:

  • Witnesses: Many states require at least one witness to watch you sign the form. The witness must be someone who is not your relative, caregiver, or agent. This rule is to make sure the DPAHC document really contains your own wishes. Some states will not accept your DPAHC as valid without the right witnesses. You can check with your lawyer if you are not sure about your state's rules.

  • Notary public: Your state may also require your DPAHC to be notarized. This means that a person who is a notary public must watch you sign your DPAHC. Your form is then stamped with the notary public's seal to complete your DPAHC.

How to make sure your wishes are known:

  • Tell caregivers and family or friends that you have a DPAHC. When you finish writing your DPAHC, talk with your family and caregivers about it. This will help everyone understand your wishes. Keep a card in your wallet or purse that says you have an advance directive.

  • Make sure your healthcare agent knows where the original DPAHC document is kept. You should keep the original document in a safe place that is easy to find. It should be kept together with the originals of any other medical advance directives you may have. Do not put it in a hidden or locked place in your home, or in your safe deposit box at the bank. Your agent may need to have the original document to show hospital caregivers for them to accept it as being in effect.

  • Make copies of your DPAHC. Give your agent a copy of your DPAHC. Let your caregivers know that you have a DPAHC and give them a copy. Make sure that caregivers put a current copy in your medical records where you get care, such as the hospital.

  • You may want to keep copies in other places. Some states have registries that keep copies of advance directives. Some services allow caregivers to access them by computer. Your church or house of worship may also be able to store a copy.

When to review your DPAHC:

You can always change or cancel your DPAHC. After you make changes, give new copies to your family, healthcare agent, and caregivers. Review your DPAHC whenever one of the following occurs:

  • Decade: You start each new decade (10 years) of your life.

  • Death: Someone close to you dies.

  • Divorce: You get divorced or there are changes to your family or personal relationships.

  • Diagnosis: You get diagnosed with a serious disease or health problem.

  • Decline: Your health worsens, and you find it harder to care for yourself.

For more information:

This information is not legal advice. Contact the following for more information:

  • Caring Connections
    National Hospice and Palliative Care Organization
    1731 King Street, Suite 100
    Alexandria , VA 22314
    Phone: 1- 800 - 658-8898
    Web Address: http://www.caringinfo.org/PlanningAhead.htm

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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