[Rhodes22-list] Not About Sailing - About Advance Directives!

[Nell]

Slim,

Thank you for your response to my posting.
If Terri Schiavo accomplishes one thing in her life, I hope it is to raise
awareness and call to action every adult to put into place written advance
directives. Sometimes, our ultimate accomplishment in life is in dying.
Perhaps she will help many of us to die with the dignity that we all
deserve.

To address your questions:
Each state has different requirements when it comes to making advance
directives. So it is important to complete a document specific to your home
state.

Healthcare Power of Attorney is the preferred advance directive document
because it indicates who will make decisions and how and what decisions will
be made. It allows an adult to designate a person (healthcare agent,
healthcare proxy, representative) to make end-of-life care decisions for
them in the event they cannot make their own decisions.

A Living Will often deals with a very narrow set of medical conditions.
Often the living will states that treatment may be stopped if the person is
terminally ill or in a persistent vegetative state. These conditions are
strictly defined by law. While the adult may think of a condition described
as "terminal" as a fatal condition, the law may define it as a condition
that will cause death soon despite treatment. Although an adult may define a
vegetative state as being useless, the law may define it as a condition
where one is permanently unconscious and the brainstem is intact.

It is possible to have both a Healthcare Power of Attorney and a Living
Will. But most of us will find that the Healthcare Power of Attorney is
sufficient. The agent or spokesperson is the Healthcare Power of Attorney.
The different terms are not meant to confuse but to offer different means
for understanding.

I am sending as an attachment a Power of Attorney for Healthcare developed
to meet the legal requirements for Wisconsin, Minnesota, and Iowa. It is
directly taken from my Facilitators Manual called "Respecting Choices" 2nd
edition, written by Gunderson Lutheran Programs for Improving End-Of-Life
Care of Gunderson Lutheran Medical Foundation.

After examining the document, I think you will see where (page 8) you can
include additional instructions or limitations such as specific
scenarios/procedures e.g. respirators, dialysis, surgery, etc or you can
leave it "open-ended". Above all, remember, this is not a static document!
As your health status changes, as designated agents die, move away, become
estranged, divorce, etc. you need to re-visit your plan to determine if you
wish to make changes. A good time to do this is annually; say when you have
your routing physical, when you do your taxes, when you prepare for a
vacation, etc.

Next time you are having an out patient procedure ask the patient
representative, the chaplain at the hospital, or even the admissions clerk
for a Healthcare Power of Attorney form. Look it over, fill it out as if you
didn't already have one, then take it home and compare it with the one
currently in place. If the "current" one doesn't reflect how you want things
done now, it's a good time to put the changes into effect.

Hope this helps. Let me know if you have more questions.

Take Care.
Nell

-----Original Message-----
From: rhodes22-list-bounces at rhodes22.org
[mailto:rhodes22-list-bounces at rhodes22.org] On Behalf Of Steve Alm
Sent: Tuesday, March 29, 2005 9:06 PM
To: Rhodes
Subject: Re: [Rhodes22-list] Not About Sailing - About Advance Directives!

Nell,

Thank you.  I know people all over the country, like me, are now scrambling
to understand this and prepare the proper documents.  Please explain the
difference between having a Living Will and a Healthcare Power Of Attorney.
Does the former require the latter?  Can the latter suffice by itself?  I
don't understand the difference between a Power Of Attorney and an "agent"
or "spokesperson."  This probably varies from state to state.  (I'm in
Minnesota)  As I understand it, some documents list specific
scenarios/procedures such as respirators, dialysis, surgery, etc. that are
to be expedited or not, and under specific situations.  But of course a
healthy adult cannot predict what may happen, so how do you allow for
something more "open-ended?"

Slim

On 3/28/05 11:54 AM, "Nell" <nellwolfe at cox.net> wrote:

> For All the Rhodes 22 folks out there,
> 
> I have written the following article for submission as a freelance writer.
> 
> I would appreciate your comments please.
> 
> 
> 
> I am an Advanced Care Planning Facilitator. It is my job to help
interested
> people in understanding the different methods
> by which they may make their wishes known regarding the extent to which
they
> would like to be kept alive in the event that
> they experience an event which renders them in varying degrees of
> incapacitation.
> 
> The first thing the reader should keep in mind is that NO Advanced
Directive
> means that family or the courts will ultimately
> make decisions about you based on what they want for you - not what you
want
> for you!
> 
> The belief that "everybody who knows me knows what I want in the event I
am
> no longer able to speak for myself" is the same
> as leaving it up to family, friends, and the courts. Terri Schiavo is the
> object of a bitter struggle between her husband, her parents,
> and the courts precisely because she left no advanced directives IN
WRITING!
> Recollections, reported past conversations, and
> incidental remarks purportedly made by Ms. Schiavo are all that is
available
> to attempt to determine what her wishes might be.
> 
> Secondly, it does not need to cost a penny to complete an Advanced
> Directive. Yes, you can formulate a Healthcare Power of
> Attorney or Living Will through an attorney but you can just as easily
> complete such a document whenever you or a loved one
> seeks care at a hospital or medical care facility.
> 
> While the specific names for the documents and some of the details
contained
> within the documents vary according to state,
> the essence of making the specifics of what you would like to have done or
> not done when you can no longer speak for yourself
> are similar nationwide. The basis for encouraging the formulation of such
> directives is a respect for individual well-being and
> the right to self-determination.
> 
> In fact, as the result of congressional passage of the Patient Self
> Determination Act in 1991, all health institutions (hospitals,
> long term care facilities, hospices, home health agencies) in all 50
states
> are required to ask all adults on admission if they have a
> written advance directive and document their responses. Further, these
> health institutions must provide written information to
> adults about their right to refuse medical and/or surgical treatment under
> the state statutes and standards and policies of the institution.
> 
> Thirdly, a person may change their written directive at any time.
> 
> To begin to think about what it means to "live well" means that each of us
> may consider our personal values, goals, religious and
> cultural beliefs. In this way we can begin to understand what we envision
> for ourselves as we live out our lives in the best possible
> manner. By making specific end-of-life treatment choices, each of us can
> begin to fashion a plan for "living well".
> 
> It is important to keep in mind that the types of decisions we make are
> greatly influenced by our health status. Healthy adults need
> only to begin to think about what they would like. While considering their
> options, it is important to begin to consider who they
> would like to act as their agent or spokesperson when end-of-life issues
> arise. Conversation with possible spokespersons is very
> important so that the agent knows clearly what the person wants and their
> feelings about types of interventions.
> 
> People with incurable, progressive diseases like cancer, congestive heart
> failure, kidney failure, chronic obstructive pulmonary disease
> need to understand the progression of their disease and treatment
decisions
> they may likely face in the future. Knowing some of the
> outcome statistics may help the person better understand the benefits and
> burdens of life-sustaining treatments.
> 
> Patients who are living in long term care facilities or are expected to
die
> within 12 months need to begin to consider what they feel
> would be a "good death". In other words, how do they envision living out
> their final months and days in the best way possible?
> It is time to talk about resuscitation - its likely outcome; options for
> withdrawing life-sustaining treatment if the treatments no longer
> serve the purpose of facilitating a "good death"; comfort care - what it
> means to the patient and under what circumstances would they
> want their symptoms controlled even if that meant that death might be
> hastened. 
> 
> Most importantly, everyone owes it to themselves and to their loved ones
to
> begin to think about advance care planning.
> Talk to your family, talk to your doctor, talk to your clergy. Ask
yourself
> the tough questions, then formulate a plan that reflects
> what you want for yourself. Take the burden of deciding off your loved
ones.
> That is the best legacy of all.
> 
> 
> 
> 
> 
> __________________________________________________
> Use Rhodes22-list at rhodes22.org, Help? www.rhodes22.org/list

__________________________________________________
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