What You Can Cover in Your Healthcare Directives

An overview of some important issues you'll face when preparing documents directing your medical care.

You have many options and a great deal of flexibility when providing instructions for your medical care. Here are some issues to consider when preparing both your healthcare declaration and your durable power of attorney for healthcare.

Your Healthcare Declaration

Your healthcare declaration is the place to write out what you do and do not want in terms of medical care if you are unable to speak for yourself. You don't need to become a medical expert to complete your declaration, but it will help you to become familiar with the kinds of medical procedures that are commonly administered to patients who are seriously ill. These include:

• transfusions of blood and blood products
• cardiopulmonary resuscitation (CPR)
• diagnostic tests
• dialysis
• administration of drugs
• use of a respirator, and
• surgery.

You can discuss these procedures with your doctor or a patient representative at a hospital or health insurance plan office, or you can turn to self-help resources for more detailed information.

In addition to the medical procedures listed above, you may want to give some thought to issues of pain medication, food and water. The laws of most states assume that people want relief from pain and discomfort and specifically exclude pain-relieving procedures from definitions of life-prolonging treatments that may be withheld. Some states also exclude food and water (commonly called nutrition and hydration) from their definitions of life-prolonging treatments. But there is some controversy about whether providing food and water, or drugs to make a person comfortable, will also have the effect of prolonging life. Some people are so adamant about not having their lives prolonged that they direct that all food, water and pain relief be withheld, even if the doctor thinks those procedures are necessary. Under the U.S. Constitution, you are allowed to leave these instructions even if your state law is restrictive; your doctors are legally bound to follow your wishes or transfer you to another healthcare provider who will.

On the other hand, you may feel concerned about how much pain or discomfort you may experience during a final illness. In this case, you may prefer to have your life prolonged rather than face the possibility that discomfort or pain will go untreated. Obviously, it's a very personal choice; you're free to leave the instructions that feel right for you.

Your Durable Power of Attorney for Healthcare

When you make a durable power of attorney for healthcare, you can give your healthcare agent as much or as little power as feels comfortable to you. Most people give their agent comprehensive power to supervise their care. Recognizing this, the power of attorney forms for most states give the person you name the authority to make all healthcare decisions for you unless you specifically place limits on that authority in the document. This means that your agent will normally be permitted to:

• consent or refuse consent to any medical treatment that affects your physical or mental health (there are usually exceptions to this rule for situations such as extreme psychiatric treatments and termination of pregnancy, and your agent is not permitted to authorize any act that violates the wishes you've stated in your healthcare declaration)
• hire or fire medical personnel
• make decisions about the best medical facilities for you
• visit you in the hospital or other facility even when other visiting is restricted
• gain access to medical records and other personal information, and
• get court authorization if it is required to obtain or withhold medical treatment, if for any reason a hospital or doctor does not honor your healthcare declaration or the authority of your healthcare agent.

Keep in mind that as long as you are able to understand and communicate your own wishes, your agent cannot override what you want. Your agent steps in only if you can no longer manage on your own. And, as mentioned, you are permitted to restrict your agent's authority in any way that you like. For example, some people give their healthcare agent only the authority to carry out the healthcare wishes specified in their declaration, and not to make other medical decisions for them.

Think carefully, however, before you add limiting language to your power of attorney. One of the most important reasons for appointing a healthcare agent is so that someone will be there to respond to the needs of your situation as it develops. Your medical needs may change in ways that you cannot now foresee, and an agent who has full power can act for you no matter what the circumstances.