Why Do I Need a Health Care Directive?

Unconscious Woman in Hospital BedWhen you think of estate planning, you probably think of making plans for disposing of your property, and possibly of appointing a guardian for your children. Most people do tend to think of estate planning as something they do to make life easier for their family after they die. While that is certainly true, you shouldn’t overlook estate planning’s role in helping your family — and you — while you are still alive. One important way to do that is through the preparation of advance health care directives.

What exactly is an advance directive? In a nutshell, it is a document that conveys your wishes for health care in the event you cannot do so yourself. Multiple types of documents fall under the umbrella of “advance directive,” including:

  • Durable Power of Attorney for Health Care, also known as a Patient Advocate Designation
  • Living Will (not legally binding in Michigan)
  • Do-Not-Resuscitate Order (DNR),which instructs health care providers not to do cardiopulmonary resuscitation (CPR) if your breathing stops or your heart stops beating.
  • HIPAA Authorization Form, which permits your medical providers to give your medical information to people you choose.

If you do not have a designated patient advocate to voice your wishes, doctors may be obligated to provide care that you don’t want and that may not help you. Having a patient advocate will help you get the health care you want, and maintain control over your treatment.

Who Makes Medical Decisions for You?

Perhaps the most essential of the documents listed above is the Patient Advocate Designation (PAD). This document, which is legally binding, appoints someone to make medical decisions on your behalf if you cannot communicate your wishes. Unfortunately, you do not always get a lot of lead time when you’re going to need a PAD. If you are the victim of a sudden, severe accident, or an illness like a stroke, you may have no time at all to appoint an advocate. That is why it is essential to not only have the document, properly drafted and executed in advance of any need, but to make sure your chosen advocate has access to it.

Who can serve as your patient advocate? Most people choose a spouse, adult child, sibling, or close friend, but any person over the age of 18 is eligible to serve. The person you choose is literally making life-and-death decisions for you, so choose someone you trust completely and who will be willing to act in this capacity. Your advocate should be willing to act according to your wishes, even if it’s not what they would want for themselves. They should also be prepared to hear input from other people who love you, and to manage conflict if there is disagreement.

Of course, before naming someone as your patient advocate, you should speak to them and make sure they are willing to accept this responsibility. You can also name a second person to serve as your advocate in the event that your first named advocate is unable to serve. Of course, you should have their agreement to be your advocate as well.

What Does a Patient Advocate Do?

What decisions can your patient advocate make on your behalf? Any medical decision you would ordinarily be able to make for yourself. You may empower your patient advocate to consent to or refuse medical treatment for you; make decisions about end-of-life care; admit you to a hospital; arrange for mental health treatment, nursing home care, physical therapy, and so on; or even donate your organs upon your death.

While your PAD allows someone you trust to make decisions for you, it may not tell them how to make those decisions. You are not required to provide them with specific directions, but the more guidance you are able to give, the better. Don’t make the mistake of assuming a loved one will just know what you want. Do you want all possible measures taken to prolong your life, even if there is no reasonable chance of recovery? Do you want measures taken for your comfort only? You may not even know what to tell your advocate, so consider having a discussion with your doctor first about what your options are and what they involve.

You can also make your wishes known through a living will. The great majority of states give living wills legal force, but Michigan, as yet, does not. Even so, your advocate can use your living will as a guide to what you would want. Having written documentation of your wishes can be a tremendous source of relief for your advocate if he or she is called upon to make a decision under stress. Also, a living will, while not binding, can inform your medical caregivers of your wishes if your advocate is not present for some reason.

If you do not have a Patient Advocate Designation as part of your existing estate plan, contact your estate planning attorney without delay to create one. You may never need it, but if you do, your loved ones will be grateful to you for thinking ahead.

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