Advance Medical Directives
A person can never be sure when illness or incapacity will strike. When this happens, many people want to know, “Who will make medical decisions for me if I am unable to make them for myself, and how can I be sure my own wishes are followed?” The best way to make certain about these questions is to designate someone to make decisions for you if you are unable to make them yourself. The person you choose will be known as your Agent. Second, you should leave instructions for that person in writing, as to what your wishes would be in the event of a sudden illness. You can accomplish both of these goals by using what is called an Advance Medical Directive. Other names for this type of document are a “Living Will” and a “Health Care Power of Attorney.”
The most important decision for you to make in preparing an Advance Medical Directive is choosing a person to make health care decisions for you should you be incapacitated, and unable to think clearly or be unable to communicate with your caregivers. The person you choose may be a relative, such as a husband, wife, child, sibling, or parent, but can also be a close friend. To whomever you choose as your Agent, it should be a person who knows you well, and whose judgment you trust, because this person may be called upon to decide what you would want to be done for yourself if you were able to make and communicate that decision.
The Instruction part of your Advance Medical Directive helps guide your Agent in making health care decisions for you. In this portion of the document, you should indicate whether you want any limits placed on your treatment, for example, if you are suffering from a terminal illness from which you are not expected to recover. Some people prefer not to be placed on life support machines if they are terminally ill. Similarly, some people prefer not to have cardiac resuscitation efforts (“CPR”) if their heart stops while suffering from an advanced illness. You should also give instructions covering your wishes about pain reliefÂspecify whether you want to be kept as comfortable as possible even if there are some potential dangers from giving you pain medication. And you should also give instructions to your Agent about artificial administration of food and water (in medical terms, “nutrition and hydration”) if you become terminally ill. Some people may want to decline to receive nutrition and hydration if it will only serve to prolong the process of dying. Lastly, your Instructions should indicate whether you would like to become an Organ or Tissue Donor upon your death. It is often possible to harvest organs (heart, kidneys, liver, lungs, etc.) and tissues (skin, cornea, bone, tendons, etc.) even from the bodies of people with chronic illnesses after they pass on.
An Advance Medical Directive can be written in any format you choose, so long as it is witnessed by two people who are not related to you (and who are not named as your Agent). However, to help with this important task, we are providing links to the websites of the State of Maryland, Office of the Attorney General Brain E. Frosh, (www.marylandattorneygeneral.gov/Pages/HealthPolicy/AdvanceDirectives.aspx) and the Five Wishes Project of the Robert Wood Johnson Foundation (www.agingwithdignity.org). You can obtain sample copies of Advance Medical Directives from either of these sites. You may certainly use either of these formats if you choose, or you can obtain other formats from your attorney, from many religious groups, or from friends or relatives who have themselves executed this type of document. Please talk to your doctor (either your family physician or one of the doctors in our practice) about your thoughts on this subject so any questions you have can be answered. Once your Advance Medical Directive is complete, signed, and witnessed, make sure you provide your doctor with a copy. That provides the best insurance that your Agent can be contacted if you are unable to make your own decisions about your treatment and care, and provides the best insurance that your own wishes will be followed.