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Advance Directives - Documents - Living Wills, Healthcare Proxies, DNRs

Step Two in the Process of Expressing Your End-of-Life Wishes

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Updated January 27, 2014

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Preparing your advance directions - on paper - will help to ensure your wishes are carried out.

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Step two in making sure your end-of-life wishes are carried out requires you develop written documentation. You'll need to consider documents like a living will, a durable power of attorney, and if you so choose, an order that will tell providers not to resuscitate you (called a DNR for "do not resuscitate".)

Legal requirements and the names for documents vary from state to state. Some require notarized signatures. Some require witnesses who are not family members to sign the documents.

Written documentation is a protection for you. The stricter the proof required that your documents are authentic, the better protected you are. Having signatures from people outside your family, including professionals, makes it much more difficult for someone to act outside your wishes.

Those requirements protect the loved one you designate as your proxy, too. With all the required signatures in place, the person who is assigned to carry out your wishes has a clear cut set of rules to follow. The professionals involved will not be able to question your intent when the proof is in place.

Once you have answered the difficult questions that help you determine your end-of-life wishes, you'll be ready to fill out the paperwork required in the state or province you live in.

If you live in more than one state, like those who live north in the summer and south in the winter, you will need to be sure the appropriate documents are written and signed for each location. Also, be sure to date the documents you develop so that if you decide to make changes later, your most current wishes will be enforced.

What Documents Record Advance Directives Decisions?

As mentioned, each state recognizes end-of-life documents differently. This is also true for the names assigned to those documents. The following are the titles heard most often, what they record, and what their intent is:

Healthcare Proxy

A proxy is both a document and a person.

Choosing someone to make medical decisions on your behalf means you have chosen that person as your proxy. It's always wise to choose a secondary proxy, too, because your primary proxy may predecease you, or may be unable to carry out your wishes for some other reason.

When proxy is used to describe a document, it actually refers to a Durable Power of Attorney (DPOA) which is a legal document, with signatures required, that describes the same information found in a living will (see below.) It may also be referred to as a Medical Power of Attorney.

Living Will

When faced with a terminal illness, a patient can create a living will that will spell out her wishes as she faces the end of life. A living will answers questions such as whether the patient wants to be fed through a feeding tube (nutrition or hydration), whether breathing should be assisted by a machine (respirator), or whether the patient's heart should be started should he go into cardiac arrest. A living will is the document that helps the patient weigh the quantity of his life against what it will take to continue his life.

DNR

This is the acronym for a Do Not Resuscitate order. A DNR spells out the conditions under which you prefer not to be resuscitated by CPR (cardio pulmonary resuscitation), so that if your heart stops, you will not be revived.

Organ Donor Card

Many parts of the human body can be donated after death with the intent to improve the quality of life, and quantity of life for others. According to the US Department of Health and Human Services, each body can provide up to 50 donations of organs or tissues, including eyes, the heart, liver, stem cells, skin and others.

For some of us, deciding to donate an organ or tissue is a simple decision. Others find the decision more difficult for a variety of reasons which may include religious beliefs.

Each state has different laws about how your wish to donate may be recorded. For example, not all states recognize a signature on one's driver's license to be sufficient. You'll want to be sure to understand the requirements in your state.

What If Your Wishes Are Not Written in a Document?

There's no question that formal, written advance directives are a much more defined outline of your wishes. But that does not mean that your wishes made orally, in conversation, will be ignored or dismissed.

In most states, a conversation between you and someone you have not formally designated as a proxy, or with a healthcare professional, can be recorded by acceptable witnesses, and will be followed. For example, if you are in the hospital and you tell your spouse you do not want to be resuscitated, and the conversation is witnessed by your doctor or a nurse, then your wishes will be written down by one of those professionals, and will be respected.

Regardless of whether your wishes are put into writing or not, making your family and loved ones aware of what those wishes are is very important. .........................................................

General Resources to Help You With Advance Care Decision Documents

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Four Steps to Expressing Your End of Life Wishes

  1. Ask the right questions and determine your answers.
  2. Record those answers in the appropriate documents.
  3. Discuss your decisions and your wishes with your loved ones and others who need to know.
  4. File or store any paperwork or electronic files you have produced, and distribute copies to the right people.

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