Talking with a loved one about your medical preferences in the event that you cannot decide for yourself is an important but rarely easy task. High profile situations such as the one involving Terri Schiavo remind us that an accident or illness could render any one of us unable to communicate our medical wishes. Planning ahead for such a situation will prove helpful to you, your family and loved ones.
"Advance medical directive" is an umbrella term that refers to written and/or oral directives you make about future medical care if you are unable to make your own decisions. This term includes a variety of documents; the two most frequently discussed are a “Living Will” declaration and a Durable Power of Attorney for Health Care.
The "Living Will" declaration is discouraged as it is a signed statement that attempts to predict your preferences in often-complex future medical situations that you cannot foresee. The statement offers a narrow list of options that may be used to prohibit treatment you may want in certain circumstances – even for a short period of time.
A Durable Power of Attorney for Health Care is encouraged as it allows you to name a trusted family member or friend to make medical decisions for you if you are unable to do so. It also permits you to name a secondary health care agent if your primary agent is unable to serve.
Signing a Durable Power of Attorney for Health Care is only part of the equation. You also need to discuss your general views, preferences and overall philosophy of medical decision-making with your health care agent.
The following "discussion categories" may be useful to help you formulate a personal medical decision-making philosophy. It may also be used to facilitate conversation with the individual(s) named as your health care agent(s). Remember that your health care agent can only make decisions for you if you are incapacitated and unable to do so for yourself.
Note: This information sheet is not intended as a legal document such as a “living will” or to be legally attached to a Durable Power of Attorney for Health Care. Your health care agent may want to write notes on this page or a separate piece of paper during and after your conversation(s) for his or her personal reference.
This document includes the following discussion categories:
I: A Life-Affirming Perspective
The writer of Ecclesiastes reminds us that there is a time for everything, including "a time to die" (Eccl. 3:1-2). Today's life-sustaining interventions may appear to create a fine line between postponing death and sustaining life. When uncertainty exists, God invites us to ask Him for wisdom when we are in need of understanding and discernment in decision-making, including medical ones (James 1:5). A pro-life philosophy on medical decision making presumes intervention will be attempted to preserve a patient’s life as long as the intervention is determined to:
II: Patient's Prognosis
Your preferences regarding medical interventions and the use of technologies may vary depending on your age, physical condition and the diagnosis and prognosis of your condition. Therefore, it may help to distinguish between the following categories when discussing your wishes with your health care agent:
III: Possible Interventions
You may have different views and preferences regarding possible life-sustaining medical interventions. Here are a few to consider:
IV: Considering Various Scenarios
Section II offers a list of possible prognoses and Section III provides a list of possible interventions. Cross-referencing these two lists may be helpful in considering and discussing your personal views and preferences with your health care agent:
How do you generally view the following possible interventions if you are in an acute medical situation where recovery is expected?
How do you generally view the following possible interventions if you are physically and/or mentally disabled, including neurological (brain) injury?
How do you generally view the following possible interventions if you are chronically ill?
How do you generally view the following possible interventions if you are terminally ill?
How do you generally view the following possible interventions if you are actively dying?
Bear in mind that patients' preferences for intervention can change over time and with life experience. For instance, many disabled patients convey that an initial desire to refuse treatment disappeared after interactions with family and friends confirmed the value of their lives, even in light of disability.
V: Additional Topics
Related topics you may want to discuss include:
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