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Advanced Directives – Speaking for You When You Can’t Speak for Yourself
Most of us find it hard to imagine let alone plan for a time when we are so incapacitated that we are unable to speak for ourselves and direct our own medical care. This is especially true if you are young, healthy, and in the prime of life. However, in the blink of an eye, a car accident, natural disaster, aneurysm, or other debilitating event can put any one of us in a medical emergency where we are unable to direct our own care.
If you’ve planned ahead, Advanced Directives are there to make your wishes known when you are unable to speak for yourself. One of the most prudent moves you can make is to work with your attorney to draft advanced directives to protect yourself and assure your care is handled in the way you desire.
If you spend a significant amount of time each year in another state, it is wise to write and keep Advanced Directives in both locations. Be sure that all Advanced Directives are consistent and tell loved ones where your Advanced Directives are kept. It is not wise to keep the only copy of your Advanced Directives in a safety deposit box at the bank. If you need the document on a weekend or holiday, you will be out of luck.
Colorado law recognizes three documents as Advanced Medical Directives. These are the living will, durable medical power of attorney, and the CPR directive (also known as a Do Not Resuscitate (DNR) directive. There is also a document referred to as MOST – Medical Orders for Scope of Treatment – that is basically a checkbox style directive that is occasionally used in nursing homes with the chronically or severely ill.
If you don’t have Advanced Directives in place and suffer a medical emergency, your loved ones may be forced to go to court to pursue guardianship in order to have the authority to make medical decisions on your behalf. All the while, you could be languishing in a hospital suffering unnecessarily.
Let’s look a little closer at the three Advanced Directives recognized in Colorado:
The living will
Also often called health care directives, spells out which treatments and life sustaining efforts you want – and don’t want – in the event that you are in a persistent vegetative state or cannot personally communicate your wishes to caregivers. The conditions of the living will do not come into play until the patient has been unable to make their wishes known (in a coma or persistent vegetative state) for at least seven days. Regardless of any provisions of your living will, physicians will continue to provide treatments to alleviate pain and minimize your suffering. Your attorney will help draft your living will, which will need to be witnessed by two uninterested parties and, if possible, notarized.
Medical power of attorney
A means for you to designate an agent or proxy who will have the ability to make medical decisions on your behalf if you cannot make them for yourself. The person you name as your agent with medical power of attorney should make your wishes known if you are unable to speak for yourself. Your medical power of attorney document should give your doctor authority to release information about your condition to your agent even before it is determined that you cannot make decisions for yourself. It is wise to also name an alternate or successor agent in case your original designee is unable to serve.
CPR or DNR directive
A document you use to request that CPR not be given if you stop breathing or your heart ceases to beat. You can get your DNR directive from your physician, who has the responsibility to consult with you about the decision. You can also get the form from the Colorado Department of Health. Your doctor must sign the form and a copy of it should be kept as part of your medical chart at your physician’s office. The DNR directive does not have to be a part of your Advance Directives and can be kept separately. It is wise to display your DNR in a place where it can easily be found, such as on your front door or on your refrigerator door so emergency medical personnel can easily find it. Occasionally, a person will wear an ID bracelet containing DNR instructions. The DNR directive can be very broad or quite limited in scope. It should give specific instructions about your wishes. In the absence of a DNR directive, emergency personnel will assume you want CPR.
Deciding on Treatments
Give careful thought to your Advanced Directives before drafting them. These are life and death decisions. Of course, you need to think about the things you hold most dear. How important it is to be self sufficient and independent? Also think about what it would take for life to no longer be worth living. Do you want your life to go on no matter what? Do you want palliative care to ease your suffering if you are terminally ill? Are you part of a religion that has prohibitions against or requirements to follow certain types of care? Are there medical conditions you have that should be addressed in the Advanced Directives documents? All these considerations are at the very heart of how you want to be cared for if you are incapacitated.
You need to specifically consider whether or not you want to be treated with mechanical ventilation if you cannot breathe on your own. If you want mechanical ventilation (breathing by machine), how long do you want it to be continued? Do you want nutritional and hydration assistance and if so, for how long? Finally, do you want dialysis if your kidneys are not functioning properly and not removing waste from your blood and managing your body’s fluid levels?
Additions to Your Advanced Directives
Two other documents you may wish to make a part of your Advanced Directives are: Disposition of Last Remains Declarations and Organ and Tissue Donation Declarations.
The Last Remains Declarations
This can also be included as part of your will. These Declarations can discuss your prepaid funeral arrangements and wishes for your memorial service, burial, or cremation. These Declarations must be signed and dated by you. Remember, if you have no Last Remains Declarations, decisions are in the hands of your relatives. If you have specific wishes, make them known.
The Organ and Tissue Donation Declarations
This can be part of a stand-alone document, handled in your living will, and also included on your Colorado driver’s license. As part of your donation, you can give instructions about who should benefit from your gift. In the absence of a declaration, this decision is left in the hands of your relatives.
Clearly, Advanced Directives are something every Colorado adult should write with the help of a knowledgeable attorney. If you live in south metro Denver, including Castle Rock, Centennial, Lone Tree, Highlands Ranch, and nearby communities, we encourage you to contact the highly skilled Castle Rock lawyers at Robinson & Henry about creating your Advanced Directives. You can call 303-688-0944 for immediate and capable assistance with this important task.