Most of us like when others follow our wishes; within our families, at work, in public — at a restaurant or a store, for example. “Do your homework!” “I need that report by tomorrow!” “May I please have some ketchup?” “Do you have these in an 8?”
Most of us would be annoyed, to say the least, if these requests were routinely ignored. Imagine then, how you would feel if your wishes regarding what type of health care you did and did not want to receive were not followed — because no one knew what they were, and you were not able to make those decisions for yourself.
There are a number of tools available to help ensure that as we age, if we fall ill — whatever happens to us — our health care wishes will be followed.
An advance directive is one way to preserve your wishes for future reference by your family and your doctors. This document is just what it sounds like; it is directions regarding your health care that you write down in advance of you becoming unable to make those decisions for yourself, whether due to the aging process, an illness or an accident.
Advance directives must be signed by you and two witnesses. It is a good idea to 1) personalize your advance directive; put a little of yourself into it; and 2) make sure your doctor has a copy.
Some hospitals will scan your document into your electronic medical record without charge. Note, however, that your wishes as expressed in an advance directive will generally not be followed unless it is first determined that you are in the advanced stages of a terminal illness or are determined to be permanently unconscious from brain damage.
Health care power of attorney
Another tool, which avoids some of the limitations of advance directives, is a health care power of attorney. This is a document you would complete while you are mentally “with it,” in which you would appoint another person, called the health care agent, to make decisions for you if you become unable to do so for yourself. Your health care agent should be someone who knows you well, who understands your values, knows what’s important to you and would be able to closely approximate the decision that you would make for yourself if you were able.
A health care agent named in a health care power of attorney has authority to make and participate in your health care decisions any time you are unable to do so yourself, whether or not you are terminally ill or permanently unconscious.
Pennsylvania’s advance directives law includes a state endorsed form that combines the advance directive and power of attorney. This form is available online, but you do not have to use this form for your advance directive or power of attorney form to be valid.
General power of attorney
A health care power of attorney is distinguishable from a general power of attorney, which will have a long list of mostly business affairs related powers that the agent has.
These powers are generally effective as soon as the document is signed, whether the person signing is incompetent or not. Although the list may include some health care type powers, this document is not going to be nearly as effective for specifically documenting your health care wishes as a health care power of attorney will be.
Another tool, which is created through a communication process between physician and patient (or the patient’s substitute decision-maker), is called POLST or Pennsylvania Orders for Life Sustaining Treatment.
POLST is generally reserved for people living with life-limiting illnesses and the elderly frail. It is an actual physician order setting forth directions for care that follows a person wherever they go in the health care system.
POLST is also generally recognized by emergency medical service providers who may follow the order after a confirmatory call to their command physician. The bright pink POLST form has been approved by the Pennsylvania Department of Health, and has been used in Lancaster County for several years now.
The guilty plea last month of Philip Benight, who admitted to assisting his wife in committing suicide last January, may lead some to debate whether or not some form of “euthanasia” should be legal in Pennsylvania.
Only four states have such laws, and no such legislation has gained much traction here. While the progression of some illnesses can be very protracted and difficult for both patient and family to endure, assisted suicide remains illegal in Pennsylvania.
People in these situations may be better served by working closely with their health care providers and, when possible, using some of the tools described above to ensure that a loved one’s wishes are followed. This means putting pen to paper before something happens leaving you unable to do so.
Everyone is a candidate for some type of advance directive. User-friendly forms like the “Five Wishes” advance directive (bit.ly/FiveWishesWill) remind us that documenting your health care wishes is just as much about declaring how you want to live as it is a map for your physicians when you reach the end of that road.
Katherine Betz Kravitz is a partner with Barley Snyder’s health care and litigation groups. She has worked with health care providers throughout central Pennsylvania.