Advance Healthcare Directives

I recently learned that April is Parkinson's Awareness Month. As many of us know, Parkinson's disease (PD) is a progressive disorder of the nervous system that affects one's movement. According to the Parkinson's Disease Foundation, an estimated seven to 10 million people worldwide live with PD with one million of those in the United States. Due to the debilitating nature of the disease, those who live with PD carry an increased possibility to develop communication difficulty, physical disability and cognitive deficiency. Therefore, patients are encouraged early on to plan for these possibilities and appoint a trusted person to make healthcare decisions when the patient cannot.

Planning for end‐of‐life decision making may be top of mind for individuals diagnosed with PD or other debilitating illnesses, but not for many of us who are in good health who fail to realize the importance of planning for medical emergencies. The reality is that at some point any one of us—healthy or not—could end up in a situation in which we are unable to make important decisions related to our own medical treatment. That is why it is so important for us all to plan in advance.

Two key documents designed to help in health care emergency situations are the Living Will and the Durable Power of Attorney for Health Care.

A living will is a written statement of an individual's health care wishes in the event of becoming seriously ill and unable to communicate. It is designed to provide guidance to someone else appointed to make health care decisions on behalf of the patient, or to the attending physician if there is no health care agent.

A living will might include:

• Directions as to pain medication.
• A discussion of any religious beliefs that might impact medical treatment.
• Instructions for funeral and burial services.
• Directions as to when to provide, withhold, or withdraw artificial nutrition and hydration, and all other forms of health care, including cardiopulmonary resuscitation. In a durable power of attorney for health care, sometimes known as a “health care proxy,” an individual (the principal) appoints another person (the agent) to make health care decisions if the principal is incapable of doing so.

Powers granted to the agent could include:

• Access to medical records.
• Authority to transfer the principal to another facility or to another state.
• Ability to authorize a “Do Not Resuscitate” (DNR) order.
• Postmortem powers to dispose of the remains, to authorize an autopsy, or to donate all or part of the principal's body for transplant, education, or research purposes. In addition to executing these documents, it is important that the individual spend time speaking with family, friends, doctors and clergy to make sure they are all aware of his or her wishes in end‐of‐life decisions. The individual should also share the whereabouts of the documents so they can be located if an emergency does occur. Also, it is important to seek professional guidance for proper preparation of advance health care directives. State law governs the use of these documents so individuals who live in different states may actually need to execute a living will and a durable power of attorney for health care in each state.