Expert Analysis of Advance Directives

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“Ask DDNC” is a new column created to serve as a resource for you. Today, we’ll focus on advance directives. We consulted Ann Jackson, MBA, for her advice. Ann Jackson is former director of the Oregon Hospice Association and now consults about end-of-life issues and options.

Every state has an official advance directive and is appropriate for all capable adults, regardless of health status at the time it’s completed. Its purpose is to protect your right to refuse medical treatment you don’t want, or request treatment you do want if or when you aren’t able to make such decisions yourself.

Many people aren’t aware that, without an advance directive, everything will be done to preserve life—even when it’s not likely CPR or other life-sustaining treatments will be successful. In this column, I’ll use Oregon’s as an example. The Oregon advance directive is straightforward and relatively easy to complete. You can complete Part B, Part C, or both, depending on your advance-planning needs. You must complete Part D and your health care representative, if you appoint one, must complete Part E—Part D is for your signature and the signatures of your witnesses, and Part E is to be signed by your health care representative accepting the appointment.

Part B allows you to appoint a health care representative to make decisions about your medical care, including life support, if you’re unable to speak for yourself. I consider Part B the more important—and critical, if you should step off the curb tomorrow into the path of the proverbial bus. You should choose your health care representative carefully to ensure he or she will respect your wishes in making medical decisions on your behalf.

It’s also important to complete Part C so your health care representative and your health care professionals haven’t only discussed your wishes with you, but have your preferences in writing. Part C allows you to document your future wishes—what medical and life-sustaining treatments you’d want if you’re unable to make your own medical decisions. You can make a general instruction for all situations or specific instructions if “you are close to death, permanently unconscious, have an advanced progressive illness, or if life support would cause you extraordinary suffering.” In each situation, you can choose to have or not have tube feeding or life support or accept the recommendation of your physician. You can also document additional conditions or instructions.

Discuss your wishes concerning medical treatment with your health care representative and doctors, initially and often, especially if your health or preferences change. Complete a new advance directive, as needed. Consider a Physician Order for Life Sustaining Treatment (POLST) if your health deteriorates to convert your wishes into doctor orders.

Do not put your original signed advance directive in a safe deposit box! Keep it accessible. Make copies for your health care representative, your doctors, family and close friends, and place in your medical records. Remember you can always revoke your advance directive and speak on your own behalf.

Help us create the next “Ask DDNC” column by telling us what questions you have in the comments section below.

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