Advance Directives

Autonomy is a luxury that we often take for granted. Living in a free society, you expect to be able to make your own choices. Some of these are routine, but some will greatly affect your life. This is especially true with the decisions you make directing your health care. Unfortunately, circumstances may arise where we are unable to communicate our wishes to health care professionals. Even in such a worst-case scenario, it is possible to maintain some control over the care you receive.

To ensure this happens, you can sign an advance directive. This is a document that states exactly what type of treatment you’re willing to receive, or designates a particular person to make these decisions for your treatment as they arise. These documents have gained in popularity recently. In the decade between 2000 and 2010, the percentage of people who used an advance directive over age 60 among those who died rose to 72% from 47%.

There are three types of advance directives that New York State recognizes: a living will, the New York State health care proxy, and a do not resuscitate order.

Living Will

A living will is a document that specifies what care you do and do not want under specific circumstances. A doctor will interpret the document based on their understanding of what you have written. The medical professional you are under the care of is the sole person who will make judgments as to your wishes, so you want to ensure you give them as accurate information as you can. Family and friends are unable to provide their own legally binding interpretation.

As such, the importance of keeping this document up to date cannot be stressed enough. Sometimes values change, or you may gain access to new information about scientific advances that change your perspective. It is critical that your living will reflects all of these changes in your mindset as they occur.

A living will is used only when you are deemed unable to make your own decisions, and a doctor verifies that your condition is incurable.

There is no standardized form, but there are samples that you can modify to incorporate your own specific needs. You can find a sample here.

New York State Health Care Proxy

In the state of New York, a health care proxy is a document that specifies someone who can make healthcare decisions for you if you are unable to. This is known as a power of attorney for health care in some states. This allows for much more flexibility in determining the type of care you will receive. Instead of a fixed document that you need to continuously update, you will need to keep clear communication with the individual you choose to direct your care.

When deciding to give someone you trust this power, it is pivotal that you clearly communicate your wishes to him or her. You are giving this person significant responsibility, and you want them to be confident as they make choices on your behalf. Without clear instructions, they may find themselves searching their memory for clues regarding your beliefs. After making some difficult choices, they may feel guilt with whatever choice they finally make, unsure if it is what you would have wanted.

You can specify precise instructions on this document that your agent is required to follow, or you can give your agent complete freedom to make choices by writing something like, “my agent knows my wishes”.

A standardized form must be used and can be found here.

Need help with advance directives for your parents? We can help. Our highly qualified and compassionate care coordinators can help make the decision easier and answer any questions you have regarding your unique situation. 

Do Not Resuscitate (DNR) Order

This is a document that states you do not want to be revived if you stop breathing or your heart stops beating. It is valid only in those circumstances, and will not affect other treatment options such as medicine or nutrition. Under this directive, a doctor will not perform cardiopulmonary resuscitation (CPR) on you. This includes: mouth-to-mouth breathing, pressing on the chest, breathing tubes, and an electric shock to restart the heart.  A physician’s signature is required for the document to be official.

You should always carry this form with you, or if you prefer, you can wear a bracelet indicating you have a valid signed DNR. A standardized form must be used and can be found here.

Choosing an agent

There are many factors that you need to take into account when choosing an agent to act on your behalf. You are also able to choose an alternate if your primary agent is unavailable to assist you. The same careful thought should be applied to choosing an alternate.

Can you trust this person to follow your wishes?

While you are able to include specific instructions in your directive that your agent must abide, it is likely this will not be able to cover all situations. You should only choose someone who you know very well, and can be relied on.

Can they and do they want to handle this responsibility?

You want to make sure that they are mature enough to make significant life and death choices, and are willing to be your agent. No matter how appropriate a person may seem for the role, you cannot force them to be your agent. Another consideration is that family members and friends may pressure your agent in making choices that you have expressed you do not want. Choose someone who will be able to withstand such pressure, and make the choices you would.

Will they be able to put personal emotions and beliefs aside?

It is best to choose someone who shares the same beliefs as you do, but if this is not possible, then ensure that the person you choose will be able to set aside their own values in favor of yours.

Are you able to remain in contact so you can give them updated information as your wishes change?

It is likely that at least some of your opinions have changed throughout your life, and will continue to do so. As such, you want to be assured you can communicate these changes to your agent in a timely manner.

Are you both comfortable having conversations about end of life care?

Open communication is necessary to take full of advantage of a health care proxy. If you think you will have trouble fully expressing yourself to your agent, then consider choosing someone with whom this will not be an issue.

You must declare in writing who will be your agent, and your alternate if applicable. If you do not do this, your family and friends can express their thoughts to the attending physician, but the doctor will not be required to follow their instructions. Even your spouse cannot fulfill this role unless they are explicitly declared your agent on the New York Health Care Proxy form.

Hospice and End of Life Care

Hospice is designed to care for people with a terminal illness who are not expected to live beyond 6 months. You are able to choose a particular hospice program before you require it. If you are unable to do this and you have declared someone as your health care agent, that person can also make this choice. This service is usually covered by health insurance plans, such as Medicare, Medicaid, or other private insurance you may have.

When should you complete an Advance Directive?

Do not wait for some arbitrary age to set up an advance directive. Accidents can happen to anyone, no matter how young. Those who use a smartphone may find My Directives an appealing option to use to declare your wishes. The platform allows you to specify your decisions regarding the care you want to receive, and can even include video posts to play to your health care provider, and agent. You are able to quickly edit this information as you wish, and your instructions are accessible on your lock screen for easy access to those who need it.

Remain in Control

Every day you delay in creating an advance directive you run the risk of having unwanted medical procedures performed on you. Additionally, your loved ones will be under more stress and pressure to figure out what you would have wanted and to convince your doctors that this is indeed the case. There is no expense required to complete these documents, as you do not need legal representation. If you are filling out a New York State Health Care Proxy, or DNR Order you need to use the standardized forms that have been linked in this post, and have them signed by two witnesses. If you decide to use a living will, you can use a sample form and revise it as you wish, as long as you have the signatures of two witnesses. No lengthy procedures are required to alter your documents. Simply make a new one, and any old ones will be invalid. Once the necessary documentation has been completed you can rest assured that you will have a much greater chance of being heard when you are unable to speak.

Looking For Senior Care

Selecting the right caregiver for your aging loved one can be tough. We help families like yours to the right type of care and find the best possible caregiver for your needs. Our highly qualified and compassionate care coordinators can help make the decision easier and answer any questions you have regarding your unique situation.

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