download a copy of Advance Directive

Everything important in life, it seems, needs planning. The career path. The purchase of a home. The children's education. Retirement. We hire financial planners and job counselors to help us map out our lives. Even in the short term, we are endlessly making plans to organize the day, the meeting, the project, and the weekend. Planning ahead, in fact, is a national pastime.

But we don't plan ahead for everything. Most of us avoid thinking about, much less planning for, the time when we may be critically or terminally ill.

Many people declare that they would not want to be kept alive by artificial means should they be in a terminal condition. But that is exactly what they may get unless they make their wishes about their future health care known. In a word, people who do not want their life prolonged artificially when there is little or no hope of recovery had better put it in writing. The way to make those wishes not only known but legally binding is by preparing a living will.

A living will is an advance medical directive - a legal document that allows a person to give directions for his or her future medical care. An advance directive is a document that clearly states a person's preference for medical treatment in life-sustaining matters. It "speaks" for the patient if he or she becomes incapable of making or voicing healthcare decisions in accepting or refusing treatment.

The Federal Patient and Self Determination Act of 1990 requires that all hospitals and nursing homes ask each individual upon admission whether he or she has an advance directive or living will. The federal legislation was designed to recognize the right of each individual to request or deny life-sustaining treatments such as respirators or feeding tubes.

Advance directives are recognized in the state of New Jersey as legal documents, which offer evidence of an individual's medical treatment preferences. (New Jersey Advance Directives for Health Care Act, 1991). The United States Supreme Court affirmed, in its Cruzan decision, that an individual's personal wishes are entitled to constitutional protection.

Advance medical directives come in three forms - living wills, durable powers of attorney for health care, and combined directives. A living will is simply a list of written instructions that explain your wishes for health care in the event that you are too ill to be able to communicate those wishes. You can write the living will yourself, or use a form that's available at hospitals, nursing homes, and physicians' offices. You do not need a lawyer; you do need two witnesses. It's as simple as that.

A durable power of attorney for health care, also known as a proxy directive, is a document in which you appoint someone to make medical decisions for you if you become unable to make your own decisions. Your attending physician cannot serve as your health care representative, nor can an employee of the institution caring for you, unless that person is a relative by blood, marriage, or adoption.

A combined directive is exactly what its name suggests - a combination of the other two. In a combined directive, you name a health care representative to speak for you if you become unable to make your decisions known. You also instruct that person as to your wishes for medical treatment.

You can use an advance directive to limit life-prolonging measures when there is little or no chance of recovery. Such measures include cardiopulmonary resuscitation (CPR), intravenous (IV) therapy, feeding tubes, respirators, or dialysis. You can also include a "do not resuscitate" (DNR) order.

You can also specify in a living will that you want comfort measures that will control pain. You can stipulate that you want to die a natural death at home with the help of Hospice volunteers who minister to you but do not administer life-prolonging drugs.

All these decisions, of course, are not ones to make lightly or without reflection. Most people who complete advance directives do so after conferring with their family members and personal physicians.

Living wills are not only useful documents for planning ahead they are also valuable tools that can help protect your right to make medical choices. You have the right to accept or refuse any procedure or treatment used, including life-sustaining treatment. You also have the right to control decisions about your health care; in the event you are unable to make your own decisions.

Once you have completed an advance directive, it's important to sign and date it, and obtain signatures from two witnesses. Keep a card in your wallet that states you have advance directives and where they can be found. Give a copy to your personal physician. If you have chosen a durable power of attorney, give a copy to your proxy.

Then go on with your life, secure in the knowledge that you've planned ahead to secure your rights, make your wishes known, and saved your family the task of making difficult decisions.

Sheila Birnbaum is Patient Relations Manager at Robert Wood Johnson University Hospital Hamilton. Contact her at 609-584-6550 for more information on Advance Directives and Living Wills.

Guidelines For Advance Directives

1. Think about your health care wishes:

• Why am I writing an advance directive?
• What are my treatment wishes in situations near the end of life?
• What are my treatment wishes in situations of serious injury or illness?

2. Talk with others:

• Do I understand the medical technology?
• Do physicians and other health care professionals understand my wishes?
• Have I directly and thoroughly discussed my wishes with my friends, family and others?
• Do they understand my wishes?

3. Select a health care representative:

• Am I confident that my designated representative understands my person values and health care wishes?
• Does my health care representative understand his or her responsibilities?
• Has he or she clearly agreed to serve as my representative and to communicate my wishes to my doctor and others concerned with my care?
• Have I selected an alternative health care representative?

4. Instructions:

• Have I clearly stated my instructions and included other relevant information about my treatment wishes regarding:
  • the provision, withholding, or withdrawal of specific treatments?
  • artificially provided fluids and nutrition?
  • the medical conditions in which I want wishes implemented?
  • special considerations I may have concerning my care and treatment?

5. Witnesses:

• Have I had my directive properly witnessed?

6. Distribution of my advance directive:

• Have I given a copy of my advance directive to those who should have one, such as:
  • my health care representative?
  • my physician or other health care providers?
  • the hospital or nursing home which I am about to enter?
  • family members, friends, alternative representatives, my priest or minister?