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Archive for Sunday, October 7, 2001

Consider questions carefully before drawing up advance directives

October 7, 2001

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Before drawing up an advance directive, think through these questions and then discuss them with your loved ones:

Who should make your health-care decisions if you can't make them yourself? Is this person someone who knows and would honor your values and views? Can he or she make complex decisions in stressful situations?

If you had an irreversible brain injury, at what point would you reject CPR, a feeding tube and antibiotics?

Do you have any religious, spiritual or philosophical beliefs central to your life that would influence what medical treatments you would or would not want?

If organ or tissue donation is a possibility, would you want to donate?

Questions to consider if you have a specific illness:

Early Alzheimer's disease: What would you want to happen if you stopped eating because of your Alzheimer's? If you developed an overwhelming infection, at what point would you want antibiotics stopped?

Progressive lung disease: Would there be a time when you would not want the support of a breathing machine?

Chronic kidney failure: Under what circumstances would you want dialysis stopped?

Congestive heart failure: When would it make sense not to attempt resuscitation?

Defining the paperwork

Advance directives are written instructions regarding the provision of health care for use when you become incapacitated. They may be completed on your own or with assistance from a health professional or an attorney.

Use the forms valid for your state and have them signed, dated and witnessed properly. Generally, health providers do not charge for the forms or for assistance in completing them. You may revoke advance directives at any time by saying they are revoked, indicating so in writing or by destroying the documents.

There are two types of advance directives. Not all states require both:

A living will states your medical treatment preferences should you become incapable of making health-care decisions.

A durable power of attorney for health care appoints a surrogate or proxy decision-maker for health care decisions should you become incapacitated. It could include any special instructions and preferences.

Other considerations

Those over age 70 or who have a progressive disease are prime candidates for writing advance directives. But anyone over the age of 18 can start to think about it. Disconnecting life support from a critically injured young person is an emotional issue that often leads to years of conflict and ends up in court when family members can't agree on what the injured person would have wanted and there is no advance directive.

The AARP estimates that 35 percent of advance directives can't be found when they're needed. Keep copies in a safe place, such as the glove compartment of your car. It's accessible then in case you're in an accident or an emergency. You also should give copies to whomever will act as your proxy in case you become incapacitated, as well as your doctor and hospital.

To be on the safe side, if you live part of the year in another state, draw up an identical advance directive using the official documents from that state.

Hospital emergency rooms may not be able to honor an advance directive since the staff may have little time to properly evaluate it.

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