Why everyone needs a living will and health care power of attorney: Health Matters - cleveland.com

Q: What are advance health care directives, and why are they a good idea?

A: Living wills, health care powers of attorney and other advance directives are written, legal instructions regarding your preferences for medical care if you are unable to make decisions for yourself. Advance directives help guide doctors and family members when patients are unable to make their own health care decisions. In extreme cases, this inability can arise because the patient is permanently unconscious or is terminally ill.

It’s important for adults of all ages to prepare advance directives, because a health emergency or accident can happen at any time.

“It’s a gift to your family to get these plans in place,” said Sally Hurme, an elder law attorney based in Harrisonburg, Virginia. “Why create chaos, indecision, confusion, frustration, turmoil — all of these may happen if you don’t have advance directives.”

Nearly 37 percent of Americans have advanced directives for end-of-life care if they become seriously ill or unable to make health care decisions, according to a 2017 analysis published in Health Affairs.

Older patients and those in hospice or palliative care were more likely to have an advanced directive, according to the 2017 report.

Here’s what you need to know about living wills and health care powers of attorney. Some information came from the Mayo Clinic website.

Health care power of attorney

Health care power of attorney is also called health care proxy, durable powers of attorney for health care, or medical powers of attorney. This legal form allows you to appoint someone to be your voice if you are unable to communicate with health care providers, explained Ronald Wayne, a trusts and estates partner with the Cleveland law firm Buckingham, Doolittle and Burroughs.

The person holding the health care power of attorney makes all health care decisions only when the patient can’t make decisions for himself or herself. This could include medical treatment, placement in a skilled nursing facility, surgery and medications. The agent also is the person who will field late-night calls from a hospital or nursing home.

It does not grant access to the sick person’s finances.

Although not legally necessary, a doctor will sometimes write a letter stating that the sick person isn’t competent to make his or her own medical decisions, said John Thomas, an attorney with Schraff Thomas law firm with offices in Willoughby Hills and Strongsville. The firm concentrates on elder law.

The person chosen to hold your medical power of attorney can be a spouse, family member, friend or clergy. If you don’t have a health care power of attorney, your nearest next of kin, such as a spouse or child 18 or older, is authorized by law to make health care decisions for you, Wayne said. (Some hospitals do not accept decisions made by a spouse or adult child without a power of attorney or guardianship, Thomas said.)

Choose someone you trust to follow your wishes when making decisions and advocate for you. You may not choose your physician or a member of your medical team. Consider naming a first and second choice.

Is that person:

· Able to understand your wishes?

· Willing to advocate for you, even if it means questioning doctors?

· Able to understand complex medical conditions?

· Available, at least by phone, in emergencies?

Living wills

A living will tells family and doctors how to proceed and outlines your wishes when you are not able to advocate for yourself in critical or end-of-life situations. Living wills are also called health care directives and advance directives.

Two doctors must determine that the patient has no chance of recovery in order for the living will to go into effect, Thomas said. Like a health care power of attorney, a living will can be revoked and rewritten at any time.

Here is an explanation of treatments that you may or may not want doctors to perform:

· Cardiopulmonary resuscitation (CPR) restarts the heart when it has stopped beating.

· Comfort care (palliative care) includes measures used to keep you comfortable and manage pain.

· Tube feeding supplies nutrients and fluids intravenously or via a tube in the stomach.

· Dialysis removes waste from the bloodstream if the kidneys no longer function.

· Mechanical ventilation breathes for you if you’re unable to breathe on your own.

· Antibiotics or antiviral medications can be used to treat many infections. If you were near the end of life, would you want infections to be treated aggressively or would you rather let infections run their course?

How to get advance directives

Advance directives can be created with or without the help of a lawyer, Thomas said. He encourages adults to use a lawyer to be sure the paperwork is done correctly. If there is a problem with a do-it-yourself form, you won’t know about it until there’s a health care crisis.

Thomas charges about $50 for advance directives.

Ohio law requires that living wills and health care powers of attorney be signed by two witnesses or signed in front of a notary public.

These forms are widely available on DIY legal internet sites, such as LegalZoom.com, for a fee.

Thomas endorses the use of an advance directive online form that has been approved by the Ohio State Bar Association, Ohio Hospital Association and other organizations.

The Franklin County Probate Court website has a packet that includes information on living wills, donor registry and health care power of attorney in Ohio. You do not have to be a Franklin County resident to access the forms.

Summit County has living will and health care power of attorney forms online.

Ways to keep advance directive paperwork safe

· Keep the originals in a secure but easily accessible place at home. Your attorney will keep copies as well.

· File the paperwork with a county recorder office, which will scan and index the documents so they are easily searchable. Cuyahoga County charges $40; Medina County charges between $28 and $40. Check to see if your county offers this service.

· Give copies to your family, doctor, hospital and the person who holds your health care power of attorney.

· Be sure the hospital adds the advance directive to your electronic medical records.

· Carry a wallet-size card that indicates you have an advance directive, gives contact information for your health care agent and states where a copy of your directives can be found.

· Pack copies to take with you during trips.

In her column, patient advocacy writer Julie Washington will answer readers’ questions about navigating health-care systems. (She will not address individual treatments.) Your comments may be published in a future story or column. Send questions and comments for publication — including your name, city and daytime phone number — to jwashington@plaind.com. You can also find Julie on Twitter @JulieEWash.

Recent Health Matters columns by Julie Washington:

Tips for finding a reliable home health aide: Health Matters

Common heart tests can tell your doctor a lot: Health Matters

What are the best ways to keep reusable bags germ-free? Health Matters

Shingles shot shortage, other related questions answered: Health Matters

Where to get help paying your medical bill

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