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Health care directives speak for you when you cannot

Editor's note: This is the third in a series of commentaries by members of the Hernando County Bar Association in observance of National Law Week.

In this age of modern miracles and medical and technological wonders, health care advance planning is extremely important for persons of all ages. A health care advance directive helps you when you cannot speak for yourself. It is a written statement concerning your future health care wishes that you make while competent.

Formal advance directives include the living will and the health care power of attorney; often, the two are merged into a single, comprehensive document. In order to ensure that your medical records file is complete, your physician will want to know if you have such advance directives. Hospitals and medical facilities are required, by law, to ask if you have one and to offer you the opportunity to execute one when you are admitted for treatment.

There is a variety of preprinted advance directive forms, but no one form is perfect for everyone and none can take the place of communication. Any form used should be personalized to reflect your own values after thoughtful discussion with your doctors, family and advisers.

Instructions to be considered may cover any health care issue, such as types of life-sustaining treatment you may want (or not want) and under what conditions, organ donation wishes, preferences regarding pain control and comfort care and preferences regarding other aspects of end-of-life care, such as your place of care. You also may designate a health-care surrogate, who is someone who can make such decisions in the event you are physically or mentally unable to do so.

In appointing an agent to make such decisions, you will need to consider who your agent, and alternative agents, will be and the scope of their authority. This is extremely important. Speak to the person beforehand and explain your intentions. Confirm his or her willingness to understand and act upon your wishes. That means talking honestly and openly about death and dying. Be sure your agent is willing to carry out your wishes, despite his or her personal beliefs. Avoid naming co-agents, as it adds potential for disagreement.

Most states require two witnesses to your signature, and some states require notarization. You will comply with witnessing requirements in most states if you avoid using witnesses who are related to you by blood or marriage, or your physician or other medical provider employed by a health care facility that is treating you or responsible for your health care costs.

You can change or revoke your advance directive while you have the capacity to do so, and no one can make a health care decision over your objection. Although you can revoke your directive orally or in writing, it is preferable to do it by writing your agent, physician and anyone else who has a copy of your directive.

It is recommended that you keep the original in a safe place where it can be easily found. Give a copy to your doctor (asking that it be made a part of your medical record), your agent (making sure he or she knows where to find the original), any successor agent or family member who is likely to be involved in decisions, any health care facility you know will be treating you in the future and your lawyer, even if he or she did not prepare the document. You may want to consider carrying a wallet-size card containing a notice that an advance directive exists. Do not hide the existence of such directives or lock up your living will with your last will and testament, where it will not be found until it is too late.

The entire purpose of such directives is to give you the opportunity to make health care and life-affecting decisions in advance, or appoint someone to make such decisions for you in the event you are unable. Such documents can ease the stress and burden placed on family members to make decisions _ such as whether or not to connect to life-support systems or, once connected, whether to disconnect _ by addressing the situation before it arises. Also, it allows appointment of an agent who may otherwise have no legal standing to provide input, such as a long-term live-in or significant other who may be close to you, but has no legal right of involvement. Conversely, without such a document, an estranged family member you haven't seen in years, and with whom you had nothing in common, may have the legal right to make such decisions.

It's in your best interest to consider executing an advance directive. Give it serious thought and put your mind at ease.

_ Gerrie Bishop is judicial staff attorney for the 5th Judicial Circuit in Brooksville and president of the Hernando County Bar Association. Guest columnists write their own views on subjects they choose, which do not necessarily reflect the opinions of this newspaper.

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