Advance Directives: Why You Should Put Your Wish (cont.)

SWANSON:
No. Not that I'm aware of.

"It's not unusual for family members to disagree about what is best for their loved one and coming to terms with being able to let go."

MEMBER QUESTION:
What do you do at your hospice if a family disagrees over whether a person should be let go or not?

SWANSON:
In a hospice setting, or with VistaCare, it's not unusual for family members to disagree about what is best for their loved one and coming to terms with being able to let go. So the best ways to address those issues are to continue an open dialogue with the family to educate them fully on the patient's condition, and the prognosis; to identify the benefits and perhaps burdens of any treatment options that might be available. And also really begin to identify what the patient's wishes would be in the situation. From my standpoint, it always comes back to that. What would the patient want?

Now if it's stated in a living will, then we know it's more a matter of the difficulty of the family members having to let go, and we can reinforce in their mind that this was truly the wishes of the patient and that it's OK and important to honor those wishes. If it's not written down, then it's more a matter of having several discussions and asking the question, based on how the patient lived their life, and based on the things they've communicated to you, what do you think they'd want done now? In most cases the communication will bring about an agreement.

MEMBER QUESTION:
Why do we have the advanced directives and then a family member or the durable power of attorney changes their mind? Even after the patient's requests have been documented and when the patient is not able to make their own decisions?

SWANSON:
If you have a living will and a medical power of attorney, can the medical power of attorney overrule the living will when you are incapacitated? There are situations where a medical power of attorney could and might overrule a patient's wishes stated in a living will. Because that's possible, it makes it extremely important that the patient, when assigning a medical power of attorney, that they clearly communicate their wishes and make sure the power of attorney is willing and able to carry out those wishes because they will be depending on them to do that.

Even though it may happen -- that a power of attorney might overrule -- when it comes right down to having to make a decision, in most cases it would not happen. Before any decision was made, the hospital or hospice personnel would discuss with the power of attorney the difference between their opinion and the patient's stated wishes, and would always advocate with the patient's stated wishes.

MEMBER QUESTION:
Can you make exceptions in this document, i.e. "if there is doubt of severity of illness, the named decision maker must get other opinions before carrying out termination of treatment"?

SWANSON:
Most living will documents will give you the opportunity to make exceptions regarding certain treatments or certain situations. If you feel strongly about those, it would be important for you to communicate that in your living will. Also, I'd add that sometimes people misinterpret the living will saying it's a document that tells medical personnel all the things they do not wish to happen in a medical crisis. But, in fact, a living will also gives an individual an opportunity to communicate what they do want. So it actually serves both purposes.

MEMBER QUESTION:
What happens when you have an advanced directive and you are visiting in another state?

SWANSON:
All states will honor living wills and medical power of attorneys. Each state sometimes has variations in regards to terms used or what exceptions can be made for residents of their state, but each state will honor a living will from a person in another state who is there temporarily. I also might add that if you move to another state as a permanent residence, it would be a good time to evaluate your current desires and wishes, and complete a new living will and medical power of attorney. You can always update either one of those documents and make changes.

MEMBER QUESTION:
Is a DNR legally binding while awaiting physician's signature?

SWANSON:
A verbal DNR will often be accepted in a health care facility, but may not be legally binding without a physician's order.

MEMBER QUESTION:
So in the absence of a hard copy, who does the medical team listen to concerning wishes?

SWANSON:
In the absence of a living will or a medical power of attorney, most states will have a list of or an order of individuals who they will turn to for determination of decision-making capability. Generally speaking, the first person on the list is a spouse, second might be either the oldest adult child or it might be a unanimous decision among the adult children. The next person, if neither of those is available or willing to serve in that capacity might be a parent, if still living, then it might go to siblings. So each state may have a different order of who they may turn to.

MEMBER QUESTION:
What if your MPA is a friend and your spouse or child challenges the legality?

SWANSON:
If you have completed a medical power of attorney form, and had it appropriately witnessed or notarized, according to the requirements of your state, then the medical personnel will always defer to the designated power of attorney. Other family members or loved ones may express their opinion, but the decision of the power of attorney will be final.

"Unfortunately, in our country, only 20% of Americans currently have advanced directives, which leaves many of us extremely vulnerable should we encounter a life-threatening illness. Don't wait. "

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