End of Life Medical Decisions
In the wake of recent events that were painfully played out in the media, we all should make appropriate arrangements for end-of-life medical decisions. Pennsylvania law provides clear guidance on living wills and medical powers of attorney, sometimes called advanced medical directives. A living will is a written expression of your choices regarding the process of dying. A medical power of attorney is broader and can communicate your wishes regarding all forms of medical care. Neither document disposes of your property or identifies the people who will inherit from you. Instead, both documents deal with your health care.
Everyone has the right to accept, reject, or discontinue medical care, but when a person cannot communicate his or her preferences or is not competent to make decisions, he or she simply cannot exercise those rights. By executing and signing the appropriate legal documents now, you can express your specific preferences about medical care and life support while you are competent and able to communicate. Later, even though the medical community cannot be forced to follow your wishes, it is more likely that your choices will be honored if your doctors have a reliable way to know and understand your preferences.
Living Will
A living will applies where medical treatment would serve only to prolong the process of dying or to maintain a patient in a permanent state of unconsciousness. It does not control medical treatment in any way unless and until you are in a terminal condition or in a state of permanent unconsciousness. A living will contains very specific directives It announces whether, once in a terminal state or permanently unconscious, you wish to have cardiac resuscitation, mechanical respiration, tube feeding, hydration, blood or blood products, surgery, invasive diagnostic tests, kidney dialysis, or antibiotics. You can opt to have some of the listed treatments and to refuse others. A living will usually identifies a “surrogate” – someone to whom you give the authority to make medical treatment decisions for you if you are in a terminal state or permanently unconscious. By identifying your spouse, parent, sibling, or trusted friend as the person who should make the medical decisions, you may help your friends and family avoid conflict.
Medical Power of Attorney
In Pennsylvania, living wills do not apply if you are in a persistent vegetative state and conscious or if you are only temporarily unconscious. They only apply to dying or permanently unconscious patients. Thus, in addition to having a living will, it is important to have a medical power of attorney for health care. In a medical power of attorney, your designate another person as your “attorney-in- fact” to make medical decisions for your if you cannot make them yourself. Your attorney-in-fact is not your attorney-he or she is your spouse, parent, sibling, or trusted friend and quite probably the very same person you named as your surrogate in your living will. This attorney-in-fact is entitled to authorize your admission to a medical, nursing, residential or other health-care facility and to require your discharge or transfer .He or she can refuse treatment, authorize treatment, and enter into any agreement for your care. He or she can act for your when you are not dying but are unable to make decisions for yourself. Pennsylvania law is not clear on whether your attorney-in –fact can discontinue life support or refuse beneficial treatment.
Living wills and powers of attorney for health care are not controlling in regard to all important medical decisions for the seriously ill. Your doctor or medical facility is not absolutely obliged to follow the terms of your living will or the directions of your attorney-in fact. Medical ethics and professional standards can potentially conflict with a living will, and no doctor or hospital can be forced to take steps they do not approve. But by signing a living will and a medical power of attorney you identify a decision-maker and clearly express your wishes regarding life support. In the event of a legal conflict, your wishes would carry weight with the court, and your identification of an individual with the authority to act on your behalf would significantly influence the court.
If you execute a living will and a medical power of attorney, be sure to have a clear discussion about your preferences with your surrogate and your attorney-in-fact. If and when asked, he or she should be thoroughly familiar with your beliefs and intentions. Also, be sure that your primary care physician has copies of your living will and power of attorney for health care.
Article provided by Williams & Scheetz, P.C. Richboro, PA