When we think about infirmity and the end of life, most of us want to make our own health decisions for as long as possible. Advance Directives include all the various ways that you can direct what you want in the event that you cannot speak for yourself.
The best way to have that happen is to decide what you want, write it down, and make sure all the right people have a copy. Of course, we do not know what the circumstances will be. It could be an accident from which recovery is expected, or it might be a terminal, irreversible condition.
Is there a person that you trust to speak for you? Do you have religious or spiritual convictions that you want honored? Your family, friends and health care team will thank you if you help them make decisions based on what you want.
Advance Directives include:
• Health Care Proxy
• Living Will
• Do Not Resuscitate (DNR) status
• Organ Donation Cards
• MOLST forms (Mass. Medical Orders for Life-sustaining Treatment)
• Powers of Attorney
All of them are voluntary, revokable and changeable. Professional legal advice is recommended but optional. All of the forms have many different versions except for the MOLST form, which is specific and bright pink for visibility.
For the moment, we are talking about only the HCP.
What is a Health Care Proxy (HCP)?
A Health Care Proxy (HCP) is a written document that names another person your “agent” to make health care decisions for you if you are incapacitated. It can be anyone you choose. It is a good idea to discuss the proxy with the person involved.
The Health Care Proxy does not take effect unless an attending doctor writes that you are not capable (possibly temporarily) of making your own health care decisions.
Attorney Julie Low of Beverly, who specializes in elder law, recommends that you plan until age 105. She says, “Choose people in the next generation, and make sure that you name at least one alternate.” Naming only an elderly spouse or siblings may not seem wise in ten years. Your chosen agents may become incapacitated themselves. Review your HCP periodically and update if necessary.
A Health Care Proxy concerns health decisions only and has nothing to do with money or property. An agent may refuse the responsibility, in which case the next named alternate takes over. Attorney Low states that only one proxy agent can act at a time. You may name more alternates if you wish. The Massachusetts form has room for only one alternate. A HCP is often combined with a Living Will. A Living Will addresses your medical and spiritual preferences, including life-sustaining treatments.
Your chosen agent may be in another state or country, but understand that accessibility is important. Having someone at your bedside when needed is valuable. It is a good idea to name an alternate agent in case. The only person who CANNOT be your Health Care Proxy is an unrelated person who is employed in a facility where you are a resident.
Your chosen agent or agents cannot be held liable for decisions made in good faith, nor can they be held financially responsible. As Massachusetts puts it, “Liability for health care costs due to decisions of an agent are the same as if the principal (you) had made the decision.”
You may cancel the HCP at any time by writing a new one as long as you are competent. You may also change your agent, your agent’s authority and your preferences for care. It is your document and your choice. A Health Care Proxy is revoked if you sign a new one.
How do I make a Health Care Proxy?
A Health Care Proxy can be done at home. You will need 2 adult witnesses. The form does not require an attorney, a notary or a doctor.
The HCP form must have your signature, and your signature must be witnessed by two competent adults who are not named in the document. Your named proxy/agent does not need to sign. Once the document is signed, make sure your loved ones and health care providers get a copy. When your health care team looks for a HCP, it is often an urgent situation. Careful planning may be wasted if the HCP is not right there for your loved ones and health care team to read.
What happens if I do not have a HCP?
Here is what Massachusetts has to say:
A competent adult’s failure to appoint a health care agent … shall create no presumptions regarding the adult’s wishes about health care.
That means that your care will proceed as usual according to medical custom. Attorney Low states that, in some cases, a valid HCP has saved a family the time and expense of going to court to obtain legal guardianship in order to make health care decisions for a relative who has lost the ability to do so.
What about a Living Will?
A Living Will is a written document stating your preferences and beliefs about medical and life-sustaining treatments. Living wills are flexible and individual.
Living Wills are not legal documents in Mass. The value of a Living Will is that it lets your loved ones and health care team understand your preferences.
There are many options for a Living Will, from the long and complicated to the simple. You may write your own. People often include personal wishes such as a list of people to notify or a particular song request for the memorial. Make sure whatever you write is signed and dated.
Massachusetts has a sample Personal Directive on its website (published in ten languages). Whatever your language, it is suggested that you do the final copy in English for your medical record. The Massachusetts sample addresses your personal values, thoughts about a peaceful death, worries and preferences regarding life-sustaining treatment.
My suggestion is to make it clear and address the issues that matter to you.
- Think about what you want.
- Write it down.
- Get copies to everyone involved (including doctors and loved ones).
- Review the form periodically. If you update it, make sure that the new one is in the right hands. If you sign a new HCP with a new date, the old HCP form is revoked providing that your health care team and agents know about it. It is up to you to tell them and give them copies.