Planning for Medical Treatment and Care

Hospice-MichiganWhat is an advance directive?

An advance directive is a written document in which a competent individual gives instructions regarding his or her health care to be followed at some future time should that person lack the ability to make decisions for himself or herself. An individual may have more than one advance directive.

What are some of the benefits of preparing advance directives?

  • Your medical treatment and personal care wishes can be honored if you cannot participate in making medical decisions.
  • You can better understand the implications of the choices you identify for your treatment and care as they impact such areas as your quality of life, family finances and the nature of the responsibilities your treatment and care might place on family members.

Why could you be unable to participate in your medical treatment decisions?

You might become temporarily or permanently unconscious from disease, accident or surgery. You might be awake but mentally unable to make decisions about your care due to disease or injury. You may not be able to communicate decisions as the result of a stroke. A degenerative condition such as Alzheimer’s disease or dementia could preclude your participation in decision-making. It is your attending physician and one other physician or licensed psychologist that makes the determination that you are not able to participate in your medical treatment decisions.

Planning is a major part of taking care of yourself and your family

Most people recognize the benefits of financial planning, life insurance, disability insurance and a will. Equally, if not more important, is the need to identify and make known your choices for medical care in circumstances in which you cannot fully participate. However, it is commonly known that many fewer people have advanced medical directives that increase the chances that their wishes will be honored than have wills or life insurance.

The subject can be difficult, but the benefits of planning in advance, before crises and with time to confer with family members and consider the implications of decisions or lack thereof for yourself and family, are profound. Preparing advanced directives before they are needed is a more effective, efficient and results in better outcomes. The odds that you will need advance directives to obtain the type of medical care you want increase with age. Simply put, it is much easier to prepare advance directives for medical care before an individual and family members are caught up in a medical emergency.

Besides specifying your health care choices, another benefit of preparing advance directives is relieving family members of responsibility for making important and often urgently needed medical decisions on your behalf in an emergency situation. Family members will not have to guess what you want and they won’t have to make difficult choices without knowing your wishes.

What are some of the common types of advance directives?

Among advance health care directives are: a durable power of attorney for health care, a living will, a do-not-resuscitate order (DNR), and a Physician’s Order for Sustaining Life Care (POLST). Living wills are not recognized in Michigan. (But in case of a dispute as to your health care desires, your written or oral statements regarding your wishes pertaining to health care or the withdrawal or refusal of treatment, may be used as evidence in court when you are unable to participate in health care decisions.)

A durable power of attorney for health care, also known as health care proxy, is a document in which you give another person the power to make medical treatment and related personal care and custody decisions for you. That person is your patient advocate. Sometimes the term patient representative is used.

The well known Five Wishes document is a living will that addresses your personal, emotional and spiritual needs as well as your medical wishes. This document goes beyond the most important medical treatment issues to address important personal issues affecting family and friends. It’s designed to facilitate discussion of and clarity about your wishes for medical treatment and related personal issues with family members, friends and your doctor.

Michigan’s Do-Not-Resuscitate Order (DNR) or Physician’s Order for Life-Sustaining Treatment (POLST) – If you have a medical emergency and ambulance personnel arrive they may look to see if you have a Michigan DNR form or bracelet or a POLST form. In the State of Michigan it is possible for a person living in a private home, a nursing home or an adult foster care facility to declare they do not wish to be resuscitated in the event their heartbeat or breathing stops. The state requires that a DNR form be signed by a physician and that a POLST form be signed by a physician or nurse practitioner.

Some Advance Directive Limitations and Considerations

There is no standard form for a comprehensive advance directive for Michigan residents. Various organizations, individual legal firms or attorneys and individuals can all prepare valid advance directives. Under state law, the designation of a patient advocate must be in writing, and you must sign the document, date it, and have it witnessed by two eligible witnesses. A person accepting the responsibility to act as a patient advocate must sign an acceptance to the designation document that contains the provisions required by the state.

Anyone of sound mind 18 years of age or older can be appointed as a patient advocate. To be valid, the patient advocate must sign a document (e.g. Section V. of Michigan’s model Durable Power Of Attorney For Health Care, the Acceptance to the Designation of Power of Attorney) accepting the responsibility. A durable power of attorney for health care designation document must be witnessed to be valid- the designation must be executed in the presence of and signed by two witnesses. The following are not eligible to be witnesses: your spouse, parent, child, grandchild, sibling, presumptive heir, know devisee at the time of the witnessing, physician, or patient advocate, nor an employee of your life or health insurance provider, nor an employee of a health facility that is treating you, nor an employee of a home for the aged where you reside in the case of certain Michigan institutions.

Hospice of Northwest Michigan can assist you in planning for your medical treatment and care

The Hospice Care Team of Hospice of Northwest Michigan and its partner, the Health Department of Northwest Michigan, is available to assist residents in preparing advance medical directives.