If a loved one appointed you in an advance directive to make his or her medical decisions, maybe you gladly accepted the appointment. But do you understand what the responsibility entails?
Advance directives such as the medical power of attorney (POA), or a living will, allow someone to provide instructions or consent for a person they appoint to continue, withhold, or withdraw certain medical treatments should that person become incapacitated and unable to make his or her own health care decisions.
During a medical crisis, however, those instructions can seem ambiguous when you’re the one responsible for making life-and-death decisions. That’s why it’s important to understand exactly what your spouse, parent, friend or other relative would want in a medical crisis.
1. Durable Power of Attorney for Health care
The durable power of attorney for health care – also known as the health care power of attorney, medical power of attorney, or health care proxy – is a legal document that allows an appointed person to make medical decisions for another person. The person named to make decisions is called the “proxy” or agent and the person appointing them is known as the “principal.”
The durable power of attorney allows the proxy to make medical decisions for the principal based on that person’s instructions if he or she becomes incapacitated and can’t make his or her own decisions.
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2. Living Will
A living will is a legal document intended to guide health care decisions for a person who is no longer able to make his or her own choices. While state laws vary, a living will is similar to a durable power of attorney for health care, but more limited.
Unlike the durable power of attorney for health care, a living will may be used only if the person also has a terminal illness or permanent unconsciousness, also known as a persistent vegetative state.
3. Do Not Resuscitate (DNR)
Another type of advance directive is the Do Not Resuscitate (DNR) order, which is sometimes called an “Allow Natural Death” order. The DNR order stops doctors, nurses and emergency medical staff from restarting a person’s heart or breathing by CPR or other life-sustaining measures such as breathing machines.
Your doctor can write a DNR that follows your wishes and advise you on how to get a wallet card, bracelet, or other DNR documents to have at home or in non-hospital settings.
4. Communication is crucial
Simply having copies of a loved one’s advance directives doesn’t guarantee you’ll understand what that person may want for every possible scenario. If you’re the agent named to make medical decisions for a loved one, have a talk with your loved one to find out their preferences in specific circumstances.
Questions to ask include whether they want CPR if their breathing or heart stops and how the person feels about using equipment to keep them alive if their kidneys or other organs shut down. Do they want to receive fluid or nutrition with a feeding tube if they can’t eat or drink on their own?
If the person has a serious illness like cancer, congestive heart failure, chronic obstructive pulmonary disease (COPD), kidney disease, Alzheimer’s, Parkinson’s, or ALS, find out if they would want palliative care to help relieve pain and remain comfortable.
5. It’s good to have both a living will and a health care POA
You can combine your durable power of attorney for health care and your living will into a single document such as Five Wishes. The form addresses personal, spiritual and emotional needs along with medical wishes. You can also include burial or cremation preferences.
The Five Wishes document is legally enforceable in most states. If the state where your loved one resides doesn’t recognize this form, that person can still complete the form to guide family members in making medical decisions.