1 / 22

Making Sense of Living Wills and Other Advance Directives

Making Sense of Living Wills and Other Advance Directives . Jack Schwartz Assistant Attorney General January 29, 2008. Risk of Future Incapacity. Who’s to decide if I can’t? What’s to be done?. Approaches. Silence + assumptions “I’ll just leave it to my family to decide”

afi
Télécharger la présentation

Making Sense of Living Wills and Other Advance Directives

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Making Sense of Living Wills and Other Advance Directives Jack Schwartz Assistant Attorney General January 29, 2008

  2. Risk of Future Incapacity • Who’s to decide if I can’t? • What’s to be done?

  3. Approaches • Silence + assumptions • “I’ll just leave it to my family to decide” • “They’ll know what to do” • Talk but no documents • Talk + advance directives

  4. “I’ll Just Leave it to my Family to Decide” • Law sets priority among “surrogates” • 1. guardian of the person (by court) • 2. spouse • 3. adult children • 4. parents • 5. adult siblings • 6. other relatives or friends

  5. Risks of Leaving Decision to Family • Deciding in the dark is hard • Risk of disagreement • Surrogates of equal rank have equal authority • Added burden, legacy of bitterness

  6. Mr. Green • 82 year-old widower, 3 children • Former smoker, had end-stage lung disease • Also had worsening Alzheimer’s disease, can’t make own health care decisions • Lived in nursing home • 3 recent breathing crises • 911 call, hospitalized, on then off ventilator

  7. Mr. Green’s Prognosis • Probable recurrent crises, back and forth to hospital • Death likely within several months • Six? Four? Two? Uncertain • Nursing home wanted to know • Hospital transfer when it happens again? • Or, no transfer, no attempts at CPR?

  8. Family Disagreement • Elder daughter: “Dad was a fighter, do everything to keep him alive.” • Son and younger daughter: “Dad wouldn’t have wanted this, and he’s suffering. It’s time to stop.” • What would Mr. Green want done? • Who would Mr. Green want to decide?

  9. Talk by Itself • Good, but is it enough? • Memories can fade • Document as reminder • Document can reassure doctors

  10. Best: Talk + Advance Directives • Don’t wait until too late • Talk with family about preferences • Document decisions in a legally valid way

  11. Types of Advance Directives • Deciding who decides: naming health care agent(s) • AKA durable medical power of attorney • Not financial power of attorney • Deciding what’s to be done: living will • Covers life-sustaining, maybe other, treatments

  12. Health Care Agents • Selection, scope of authority up to individual • Agent to decide based on • “Wishes of the patient,” unless “unknown or unclear” • Then, “patient’s best interest” • Ask your agent to read Proxy Handbook

  13. Living Will • Follows “If … then …” model • “If I lose capacity and I’m in [specified conditions], • Then no CPR, ventilator, feeding tube, etc.” • Or: aggressive interventions requested • Decision to forgo carried out if two physicians certify: • Terminal condition • End-stage condition • Persistent vegetative state

  14. Terminal Condition • Incurable • No recovery even with life-sustaining treatment • Death “imminent” • When’s “imminent”? • Up to doctors

  15. End-Stage Condition • Progressive • Irreversible • No effective treatment for underlying condition • Advanced to the point of complete physical dependency • Death not necessarily “imminent” • Primarily advanced dementia, maybe other diseases

  16. Persistent Vegetative State • No evidence of awareness • Only reflex activity, conditioned response • Wait “medically appropriate period of time” for diagnosis

  17. Doing Both: Effect of Instructions on Agent • Living will usually controls • Why? Clear evidence of what patient would want done • Do you really want to bind your agent? • Living will can be made non-binding guidance

  18. Maryland Formalities • Two witnesses • Notary not required • Statutory form optional -- other forms okay • Out-of-state advance directives valid here • Maryland directive elsewhere? Depends on that state’s law

  19. Changing or Revoking an Advance Directive • Presumed valid, no expiration • New one on same topic revokes old • Only patient may change/revoke • Family cannot • Review it now and then • Agents still available? • Contact information current? • Care preferences the same?

  20. Some Pitfalls • Advance directive done secretly • “What? I’m his health care agent?” • “I know that’s what it says, but she didn’t understand.” • Using ambiguous language • “No heroic measures.” • Are you sure about a treatment decision? • Mexican proverb: “The appearance of the bull changes, once you enter the ring.”

  21. Making It Work in the Real World • Copies to family/friends, doctor and hospital • Wallet card or (soon?) Maryland registry • Want comfort measures in case 911 is called? • Special order form (EMS/DNR Order) needed from doctor

  22. More Information: Attorney General’s Office • Forms: call 410-576-7000 • Forms and other information via the Internet: • www.oag.state.md.us • Then click on “Advance Directives/Living Wills” • Much other material on Maryland law and policy • www.oag.state.md.us • Then click on “Health Policy”

More Related