Advance Directives have become a common topic for many organizations as we experience a push to have the “conversation” and plan for our end of life care. Over the past few years, a great deal of grant money has poured into the effort to get everyone to have some written documentation of how they want to be treated at the end of life. In most cases, this simply means that the individual put in writing their desire to not have further medical treatment if medical personnel deem such treatment futile. Usually, that is what a Living Will states.
The Living Will, however, is just one aspect of the Advance Directive. The other, and in my opinion, the more important document is the Health Care Power of Attorney. This is the document naming someone to make medical decisions for you if you can’t. Because a Living Will only applies in a very narrow situation – usually impending death – it is of limited use. These situations are always unique, and it is often preferable to have someone who understands your desires to be able to react to changes in condition and variations in opinions. Medical people can often have different opinions as to diagnosis and prognosis. Medical science is not pure science – it is also an art. Medical providers have different levels of knowledge, experience, and expertise. So when your document says, “I want no life-sustaining measures if the doctor thinks my death is imminent,” maybe not every doctor would think so. Maybe you would want another opinion but cannot express that because you’re in a coma. That’s where your agent under the Health Care Power of Attorney comes in. I am finding more and more clients are opting not to have a Living Will, but to focus their effort on choosing good agents to name in their Health Care Power of Attorney and informing those agents of what types of care they want in various circumstances.
Another one of the Arizona forms sometimes included with Advance Directives is the Prehospital Medical Care Directive or Orange Form. I have noticed many people going to the proliferating Advance Directives seminars or workshops are being encouraged to complete this form. Legislated to be on orange paper, this form essentially allows emergency personnel (mainly first responders and ER staff) to withhold cardiopulmonary resuscitation (CPR). There is no requirement to evaluate if providing CPR would be futile or not. For many of us in reasonably good health, CPR could certainly save our lives, and we can return to the quality living. For example, someone may have a cardiac arrest from an electric shock, inadvertent drug overdose, or even choking. These people can be easily brought back with CPR done in a timely fashion. But the Orange Form says – “Don’t ask questions! Just do nothing!”
I recommend the Orange Form only be used by people with truly terminal conditions, such as people on hospice or eligible for hospice, or for people for whom CPR would be detrimental. Unfortunately, this does not seem to be the advice given in some of the workshops, and seminars that are springing up. I question their advice. What’s your hurry? If you cannot be resuscitated (because you are dead), you won’t be aware of the CPR. If you are resuscitated and further treatment is futile, then your agent can have sufficient information to make a good decision based on your previous discussions with them. What’s your hurry?
Again, Advance Directives are essential. In most cases, though, the most useful document is a good Health Care Power of Attorney naming people who know what you want and can react to changes that often happen minute to minute when people are very sick.