WHAT YOU NEED TO KNOW: What is a durable power of attorney for healthcare? A durable power of attorney for healthcare (DPAHC) is a type of written legal document called a medical advance directive. It allows another person to make healthcare decisions on your behalf. This person is called a healthcare agent. Your healthcare agent speaks for you if you are too sick or injured to make your wishes known. Why may I want to have a DPAHC? If you are in the hospital, you or your family will be asked if you have any advance directives, such as a DPAHC. If you do not, your healthcare providers may give you treatments you do not want. You could live for months or years with these treatments, but not be conscious or aware. If you have a DPAHC, your agent will tell your healthcare providers which treatments you want. What types of decisions may my healthcare agent make for me? Your agent can get information from any of your healthcare providers to help make decisions about your treatment. Your agent can talk about treatments with your healthcare providers and ask for second opinions. Your agent can transfer your care to another healthcare provider or healthcare facility, such as a hospital or a skilled nursing home. Your agent makes decisions based on the information you put in your DPAHC. If your agent is not sure of your wishes, he will do what he thinks is best for you. You may want to limit what your agent can decide for you. Make sure your healthcare agent and healthcare providers know about these limits. - Medical care: You can have your agent make decisions to start, stop, or refuse any of the following on your behalf:
- Antibiotic (germ-killing) medicines
- Chemotherapy or radiation therapy to treat conditions such as cancer
- Diagnostic (finding) tests and invasive or painful procedures
- Dialysis to remove wastes from your blood
- IVs to give you liquids or tubes to give you food
- Major surgery
- Resuscitation (restarting your heart and breathing)
- Ventilation (a machine breathes for you)
- End-of-life decisions: At the end of your life, your agent can carry out your last wishes about the following:
- Autopsy: You can decide to have healthcare providers perform an autopsy (exam to find cause of death).
- Donation: You can decide to donate your organs or tissues for transplant. You can also decide to donate your body for research.
- Funeral and burial: You can decide how you want your funeral planned. You can also decide if you want to be buried or cremated.
When does a DPAHC take effect? Your DPAHC takes effect when you can no longer let healthcare providers know what care you want. This may happen if you are unconscious (cannot be awakened). It may happen if you are not able to think clearly or cannot communicate to others what you want. Depending on your state's laws, 1 or 2 doctors must decide that you can no longer make medical decisions, even if you can communicate with your healthcare providers. How do I choose my healthcare agent? Healthcare agents are often family members or close friends. You must trust your healthcare agent to understand the care you want and to respect your wishes. Choose an agent you trust to follow your wishes, even if your wishes differ from his. Your agent must be at least 18 years old. He should be willing to stand up for what you want. Try to choose someone who lives nearby and will be around for a long time. Most states do not allow your doctor or other healthcare providers to be your healthcare agent, unless they are related to you. What do I need to think about when I prepare my DPAHC? Ask your healthcare provider for worksheets or forms to help you write your DPAHC. These will help you to prepare written instructions for your medical and end-of-life care. Think about the situations where you may want to limit your medical treatments. Tell healthcare providers your wishes if you have a healthcare problem, such as cancer or lung disease. Even if you are not sick, accidents or injuries can cause severe brain injuries. You will want healthcare providers to know your wishes if you are injured. Some treatments will keep you alive, even if you will not get better. Treatment options include the following: - All treatment to try to save your life.
- All treatments, but stop them if they are not working within a certain time.
- Only treatments that do not cause pain or discomfort.
- Only palliative (comfort) care. Comfort care provides medicine to take away pain, but not treatments to save or prolong your life.
In what situations may I want to limit treatment? Think about the following situations. Then think about the treatment you would want if there is little chance you will get better: - You need a wheelchair to get around, or you need a ventilator to breathe.
- You have constant or severe pain, nausea, or diarrhea.
- You need healthcare providers to feed, bathe, and help you go to the bathroom. You cannot control when you urinate or have bowel movements.
- You must be fed through a feeding tube, or you need kidney dialysis to remain alive.
- You cannot think or communicate well, or you no longer recognize your family or friends.
Do DPAHC forms allow me to express my values, beliefs, and quality of life preferences? Many DPAHC forms give you a place to describe what you value and believe about your life. Think about your answers to questions like these: - What activities make your life worth living? You may value communicating with your family and friends most of all. It may be most important to be able to move freely and to go outside. You may believe that thinking clearly and taking care of yourself make your life most meaningful.
- What are your fears about the end of your life? Is it important to have pain relief? Or do you want to remain aware and alert, even if you are in pain?
- What do you want others to know about your religion or beliefs? Are there certain practices in your religion, such as prayers or blessings, that you want followed before you die?
- What kinds of support do you want at the end of your life? Who do you want with you? Would you like to be at home or in hospice care?
Where can I get a DPAHC form? Your hospital and healthcare providers should have the forms or worksheets that are used for your state. Each state has rules for DPAHC and other advanced directives. Most states allow advanced directives prepared in one state to be used in another state. You may still want to create DPAHC for more than one state if you travel often or spend time in another state. How do I prepare a DPAHC? - Choose a healthcare agent and decide if you want to limit the agent's decisions. Make sure your agent knows your choice and agrees to help you. Write down any limits you want on the healthcare decisions that your agent can make.
- Write down the treatments you want and do not want. Ask your healthcare providers to explain any treatments you do not understand before you make decisions about them. It may help to list the treatments you always want and never want. You may want some treatments only when there is a good chance that you will get better. For example, you may want a feeding tube while you recover from surgery. You may not want a feeding tube if you have been in a coma for 6 months or you have a long-term brain injury. You can start treatment and then stop if treatment is not working. You may want to refuse or stop treatments that prolong life but cause constant or severe pain. You may be willing to have pain, if treatment allows you to live longer.
- Write down your wishes about other decisions you want your agent to be able to make. You may want a religious or spiritual leader with you to say prayers or blessings. You may want to be at home or in a hospice. If you want to donate your body or organs, write this on your form. You may want your funeral or burial planned a certain way.
- Talk with your family and healthcare providers about your wishes. They will have questions for you. These questions may help you better prepare your DPAHC. Your healthcare provider may not agree with your wishes. If this happens, you will need to find another healthcare provider to help you.
What are the legal requirements for signatures on a DPAHC? You do not need a lawyer to write a DPAHC, but it must follow the rules of your state. The legal requirements may include the following: - Witnesses: Many states require at least 1 witness to watch you sign the form. The witness must be a person who is not your relative, healthcare provider, or your agent. This rule is to make sure the DPAHC document really contains your own wishes. Some states will not accept your DPAHC as valid without the right witnesses. You can check with your lawyer if you are not sure about your state's rules.
- Notary public: Your state may also require your DPAHC to be notarized. This means that a person who is a notary public must watch you sign your durable power of attorney. Your form is then stamped with the notary public's seal to complete your DPAHC.
How do I make sure that my wishes are known? - Tell healthcare providers and family or friends that you have a DPAHC. When you finish writing your DPAHC, talk with your family and healthcare providers about it. This will help everyone understand your wishes. Keep a card in your wallet or purse that says you have an advance directive.
- Make sure your healthcare agent knows where the original DPAHC document is kept. You should keep the original document in a safe place that is easy to find. It should be kept together with the originals of any other medical advance directives you may have. Do not put it in a hidden or locked place in your home, or in your safe deposit box at the bank. Your agent may need to have the original document to show hospital healthcare providers for them to accept it as being in effect.
- Make copies of your DPAHC. Give your agent a copy of your DPAHC. Let your healthcare providers know that you have a DPAHC and give them a copy. Make sure that healthcare providers put a current copy in your medical records where you get care, such as the hospital.
- You may want to keep copies in other places. Some states have registries that keep copies of advance directives. Some services allow healthcare providers to access them by computer. Your church or house of worship may also be able to store a copy.
When should I review my DPAHC? You can always change or cancel your DPAHC. After you make changes, give new copies to your healthcare agent and your healthcare providers. Review your DPAHC whenever one of the following occurs: - Decade: You start each new decade (10 years) of your life.
- Death: Someone close to you dies.
- Divorce: You get divorced or there are changes to your family or personal relationships.
- Diagnosis: Healthcare providers diagnose (find) a serious disease or health problem.
- Decline: Your health worsens, and you find it harder to care for yourself.
Where can I get more information about a DPAHC? This information is not legal advice. Contact the following for more information: - Caring Connections
National Hospice and Palliative Care Organization
1731 King Street, Suite 100
Alexandria , VA 22314
Phone: 1- 800 - 658-8898
Web Address: http://www.caringinfo.org
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