During one’s life, there are many situations likely to require the designation of a surrogate to perform certain acts. It can be as simple as signing a paper for your friend to collect a parcel for you or giving a lawyer the authorization to represent you in a case. Advance directives fall in this category of deeds. The term “advance directives” refers to a statement of treatment preferences and usually includes the designation of a surrogate decision-maker if the person signing the advance directives becomes unable to make medical decisions by himself.
In such cases, power is given to the surrogate for one or more tasks and for a determined period. You don’t want to give unlimited powers allowing a person to act on your behalf for an unlimited period. Advance directives, as they are designed, can fall into two categories: living will, and durable power of attorney for healthcare. We examine each of them separately to better outline the differences.
A living will is reported to be the oldest form of advance directives. It is a signed and witnessed document (usually by a notary public) instructing an attending physician not to provide medical intervention of any form on its signer in case he/she is unable to make sound medical treatment decisions for him/herself, or if the patient is in terminal condition. There is, however, a risk as to the interpretation of the instruction by the physician who might not always be acquainted to the patient’s values and therefore, misunderstands his wishes. In any case, the physician is the only person with a legal standing to interpret the instructions and act upon them; family members or relatives don’t have the capacity to enforce these directives.
A durable power of attorney for health care is also a signed and witnessed document in which the signer identifies and designates a third party who becomes his agent, to take health care decisions on the signer’s behalf in the event he or she becomes temporarily or permanently unable to do so. The peculiarity of durable power of attorney for healthcare is that they usually don’t require the signer to have a terminal condition. The designed agent will have a great scope of responsibility since he will be able to make crucial decisions as whether treatment should be provided or withheld, or if the medical care should be completely withdrawn. He is also able to choose what type of treatment should or shouldn’t be administrated to the signer. For these reasons, the choice of the agent must not be made carelessly. The signer must take time, while still in his/her full mental capacity, to discuss his/her values with the prospected agent, as well as his/her wishes and instructions. This should be done before the document is signed and, necessarily at the moment when the signing takes place. It is not prohibited to continue the discussions after the signing to make sure the agent really assimilates the wishes of the signer; doing so is advisable. An important part of the whole process is to get the assent of the prospected agent. It would be useless to choose and designate someone who is not ready to act on one’s wishes. The agent must make sure, in due time, that the instructions of the signer are enforced. That is the philosophy behind the entire process.
It is reported that in the US, four out of five adult people have no advance directives.
Giving advance directives becomes important when the patient becomes incapacitated and therefore can no more make valid decisions regarding his/her own health care. Until then, the patient remains the sole decision maker regarding his/her health. Instructional advance directives are widely advocated as a means of preserving patient self-determination at the end of life based on the assumption that they improve surrogates’ understanding of patients’ life-sustaining treatment wishes. However, no research has examined whether instructional directives are effective in improving the accuracy of surrogate decisions.
Nowadays, millions of people sign advanced directives hoping that they would be acted upon in case they lose the ability of making sound decisions. However, it is sometimes harder than it should be. It happens that the advance directives are not acted upon either because their existence is not known, or the family firmly stand against the instructions. Nevertheless, in most cases when their existence is known, the recommendations contained in advance directives are followed by the physician or the agent.
So, have you given, or would you give advance directives?