Health Care Decision Making

What is involved when it comes to an individual’s health care decision making?

We heard some disturbing news last night. There was a hospital in Chicago that was trying to compel all COVID 19 patients to sign DNR’s or do not resuscitate orders so that they wouldn’t need to be resuscitated. As our health and public health is at the forefront of minds today, we wanted to provide information for you to consider in these trying times.

Who will handle your health care decision making?

This is a good opportunity go over a couple of things here in Pennsylvania. We get a lot of common questions: who can make my medical decisions? Who gets to pull that proverbial plug? We’re going to answer a lot of those questions here today.

The important question here is who makes my medical decisions.

Well, you do. You will always make your medical decisions unless you are unable to because you’re incompetent, unconscious, too sick, or not able to comprehend those decisions. If you have a health care power of attorney or have appointed a health care agent, then your health care agent will make those decisions. If you don’t have a health care agent in place and you’re not able to make those decisions for yourself, then the law does provide that your spouse and next of kin could make those decisions.

There’s some key documents that you want you want to have in these situations. First would be a health care power of attorney. Second would be a living will and we will discuss another document that you would not create called a physician’s order for life-sustaining treatment or a POLST. This is not a document that you would prepare, but rather your doctor, but it’s important to understand how those work in conjunction with the documents I just mentioned.

I’m not going to go into detail, but another key document is a durable power of attorney that allows someone to make financial decisions for you if you’re not able to. We will probably release more resources on this topic shortly.

What is your health care power of attorney?

A health care power of attorney appoints a person or persons who can make medical or personal care decisions when you cannot. The health care power of attorney only comes in to play when you are not able to make those decisions for yourself.

It’s important that you pick someone that you trust. You need to be able to trust their judgment because they’re going to be making some really important decisions for you. If you’re married usually that person would be your spouse, but it’s also important to make sure that you have successor agents God forbid something happens to your spouse.

What should be in a health care power of attorney?

You want to provide some guidance to the agent as to what your wishes are. You want to also tell them. Talk to your agent, don’t rely just on the written document. Make sure that your agent knows what care you want or don’t want because they will have some important decisions to make.

The Health Care Agent can authorize tube feedings on your behalf, consent to treatment or withdraw treatment, and can consent to organ donation and they can obtain health care information on your behalf. Your agent would also be able to obtain any HIPAA protected information on your behalf.

What’s the living will?

A living will is a document providing instruction for your end-of-life care. A lot of people ask the question, “When do we pull the plug?” The living will is what provides those instructions. The living will is only effective if your attending physician determines that you have an end-stage medical condition.

What’s an end-stage medical condition?

It means that your doctor has determined that you have advanced disease that will cause your death despite the introduction or continuation of treatment. Also, if you are in the state of permanent unconsciousness with no realistic hope of recovery (a coma or vegetative state) where you are not expected to come out of that out of that state, a living will allows you to memorialize your decisions in advance.

The Living Will allows you to decide what care you want or don’t want like life-sustaining procedures; do you want medication; do you want antibiotics; do you want to be made comfortable with drugs or other interventions to allow you to be as comfortable as possible as you pass away. Your wishes need to be followed not only by your agent, but by any medical facility – they are obligated to follow these instructions.

What is your physician’s order for life-sustaining treatment?

This is a medical order. It’s crafted by the doctor and the patient. If the patient is not able to participate, then the agent under the health care power of attorney would participate. It is applicable only to a current medical condition. The living will and the health care power of attorney are general documents that would apply to any medical condition.

The physicians order for life-sustaining treatment is going to be only applicable to the current condition that you have and it’s typically only used if there’s an advanced progressive illness. It’s important that the doctor and the patient or the patient’s agent review it periodically because things certainly change and can change pretty rapidly.

So what should you do now?

If you have a health care power of attorney, you want to read it and make sure you still agree with it. Make sure your doctor or hospital has it in your medical file. Make sure your agents or/and successor agents have it or know where it is. This is critical because if the doctor or the hospital doesn’t have this document they can’t honor it.

In our practice, when we prepare health care powers of attorney and living wills, we generally tell them to take it down to their doctor or hospital on their next visit. If for some reason you end up going to the hospital where you become ill, you want to make sure that you have it with you just in case it can’t be located. You want to make sure that you get the care that you want; not the care that someone else decides for you.

Most importantly, if you don’t have these documents you want to get one today. It’s so critical particularly and as we’re facing this public health crisis, you want to make sure that you have your wishes in writing; that you have appointed people that you trust to make your decisions.