Doctor, how can I best communicate my wishes for medical care?
Most patients eventually must face the process of planning for their future medical care. However, few Americans have a living will or a durable power of attorney for health care. These advance health care directives provide a legal basis for physicians to carry out treatment, but they also should reflect the patient’s values and preferences. Primary care physicians are in a position to integrate medical knowledge, individual values and cultural influences into end-of-life care. These physicians can best respect the autonomy of patients by allowing the patient and family to prospectively identify relevant health care preferences, by sustaining an ongoing discussion about end-of-life preferences, and by abiding by the decisions their patients have made.
A 1990 U.S. Supreme Court decision drew attention to the issue of life-sustaining treatments for patients who are unable to make their own decisions. This case affirmed a state’s right to require “clear and convincing evidence” for wishes concerning life-sustaining medical care. The Patient Self-Determination Act (PSDA) was written in response to the case. The PSDA requires hospitals, nursing homes, and health care programs to ask patients about advance directives and then incorporate the information into medical records. The living will, a written advance directive, allows a competent person to indicate his or her health care preferences while cognitively and physically healthy. A living will may list medical interventions the patient would like withheld or withdrawn when he or she becomes unable to communicate. Another type of advance directive, the durable power of attorney for health care, allows persons to designate a proxy (or surrogate) to make decisions for them if they become incapacitated.
There are several types of advance directives:
A standard advance directive tells your doctor what kind of care you would like to have if you become unable to make decisions, (e.g. if you are in a coma). If you’re admitted to the hospital, the hospital staff would probably talk to you or your proxy about advance directives. A good advance directive describes the treatment you would want depending on how sick you are. It also gives you the opportunity to identify a loved one who will act on your behalf and make sure your wishes are carried out. In California, under Probate Code Section 4701, there is an accepted advance health care directive that allows you to make these decisions and put them in writing.
A durable power of attorney for health care is another kind of advance directive. A durable power of attorney states whom you have chosen to make health care decisions for you. It becomes active any time you are unconscious or unable to make medical decisions. A durable power of attorney is generally more useful than a living will. But a durable power of attorney may not be a good choice if you don’t have another person you trust to make these decisions for you.
A living will is one type of advance directive. It is a written legal document that describes the kind of medical or life-sustaining treatments you would want if you were seriously or terminally ill. A living will doesn’t let you select someone to make decisions for you.
A do-not-resuscitate order is another kind of advance directive. A do-not- resuscitate order is a request not to have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. (Unless given other instructions, hospital staff will try to help all patients whose heart has stopped or who have stopped breathing.) You can use an advance directive form or tell your doctor that you don’t want to be resuscitated. In this case, a do-not-resuscitate order is put in your medical chart by your doctor.
In California, by filling out an advance directive, you are able to use the power of attorney and appoint a proxy. You are able to give the instructions for health care and you are also able to express your wishes with donation of organs and designate who is the primary care physician.
To fill out an advance directive or for more information, please attend Citrus Valley Health Partners’ “Make Your Wishes Known Day” on Nov. 9. At different times during the day, each of the three CVHP hospital campuses (Foothill Presbyterian Hospital in Glendora, Citrus Valley Medical Center - Inter-Community Campus in Covina and Citrus Valley Medical Center - Queen of the Valley Campus in West Covina) will offer the opportunity for the public to come in and fill out an advance health care directive for free. Health care professionals will be available to guide you through the simple process of making your wishes known. Free notary service will be provided and Spanish-speaking interpreters will be on hand.