Advance Medical Directives


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What is an advance medical directive?

An advance medical directive appoints an “agent” to take one or more actions on the behalf of the “principal” signing the advance medical directive.

Why do I need one?

Because we all need an advocate when we can’t speak for ourselves. Your directive appoints an agent who can access your health information, and if you are incapacitated, your agent can make sure that your medical providers honor your wishes, preferences and decisions regarding your medical care/treatment and final care.

Why do I need to get one now?

Because no one plans on being incapacitated. Even if you aren’t incapacitated, your agent can help you by receiving your health information and asking questions of your doctors and other health care providers about particular care or treatments. When you are foggy or hazy after a medical procedure, this additional assistance can be invaluable in making the right choices.

Do I need a successor agent?

It is generally advisable, yes. Your agent is human too, after all, so your agent may move away, travel abroad, be injured, become incapacitated, or die. Also, if you and your agent are together frequently, there is always a risk that the two of you will be incapacitated in the same event (a car accident, for example). Sometimes, particularly with medical issues, family members find themselves unable to make critical decisions. In such a situation, your successor agent can step up and make sure that your wishes are honored.

Do I need to update my advance medical directive?

That depends. Like the rest of your estate plan, you should review your advance medical directive at least every 3 years to make sure that your agents are all still alive, available, and willing to serve, and that you still want your agents to act in the order in which you have previously appointed them. Your understanding of your agent’s abilities may change over time, for instance as you witness how they handle other matters. This may mean that an agent no longer needs a co-agent to help them do a good job, or that you have discovered that someone you thought was able to act by themselves will really need some help to do a good job. You may also come to realize that there are certain assets over which your agent needs to have a power that you had previously withheld, or that there are powers you previously gave to your agent that you no longer wish your agent to have.

They offer a form for this at the hospital. What’s different about the form you offer?

The answer to this question depends in part on which hospital you find yourself in, but the primary difference is that this form is designed to be more specific and to cover a wider range of preferences. For instance, many local hospitals use a form that treats all life-support treatments the same, including artificial respiration, artificial hydration, and artificial nutrition. In addition, we address religious beliefs and related treatment preferences, and we provide you with a range of options regarding a specific treatments and requests for your care, instead of a blank space to describe your preferences like you will find on a hospital form.

I’m a veteran. What do I need to know?

If you have already executed a health care power of attorney form through the V.A., then that form will be valid throughout the V.A. system. But you should have an advance medical directive that is valid under state law for use outside the V.A. system. This can be especially important in an emergency room situation. The V.A. is not obligated to honor an advance directive that is not on their form, so it is advisable that you have both documents.

What is the most important thing I need to decide before I start the intake process?
As with your general power of attorney, your choice of agent is probably the most important decision when making an advance medical directive. You should make sure that you can answer “yes” to each of these questions:
- Do I really know and trust them?
- Do they understand my feelings and point of view?
- Will they follow my wishes if I are unable to advocate for myself?
- Will they be willing to commit to the time and energy required to be my agent?
- Are they willing and available to visit me or keep in contact with me?
- Are they good with tough decisions or do they crumble under pressure?


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