Advance directives – make the decision yourself

By Adriana Cortes

Nearly 1.5 million Americans suffer some sort of brain injury each year in motor vehicle accidents, falls, and sports and recreational accidents. Many are neither heroically rescued, nor lost. Instead, their bodies are kept alive through life-sustaining treatments (such as ventilators and feeding tubes) with about a 1% chance of regaining their ability to communicate, and their families are devastated emotionally and financially. This could happen to anyone.

It is important to have an advance directive so that your wishes will be followed in such a catastrophic event. This prevents your family from being left with the burden of determining whether you would want to remain alive on life-sustaining equipment or not. Imagine their worry that they might not be making the right decision for you, and the family disputes that could arise. You can easily avoid burdening your family with this dilemma with an advance directive.

What Is an Advance Directive?

An advance directive is a legal document designed to help you communicate your wishes about medical treatment at some time in the future when you are unable to make your wishes known because of illness or injury. There are three types of directives that Texas law recognizes: Directive to Physician (also called a Living Will), Medical Power of Attorney, and Out-of-Hospital Do-Not-Resuscitate Order. They are described in more detail below.

Living Will

After considering your personal values, and the consequences and benefits that might accompany your decision, make your choices known in the Living Will form and have two witnesses sign it. These witnesses may not be family members, medical providers, or anyone who might have an interest in your estate. The form does not need to be notarized. If you are under the age of 18, you must have your parent, legal guardian, or spouse (if 18 or older) fill out the directive for you.

Medical Power of Attorney

The Medical Power of Attorney form allows you to appoint someone your agent to make health care decisions for you in the event that you are judged “incompetent” to make these decisions by your attending physician. You may not appoint your health care provider or residential care provider, or any employee of theirs, unless that person is also a relative. Like the living will, this form must be signed by two witnesses.

Do-Not-Resuscitate Order

A Do-Not-Resuscitate Order (or DNR) communicates your wishes in an out-of-hospital setting such as a hospice, private home, outpatient or emergency room, or ambulance. This directs professionals to withhold cardiopulmonary resuscitation (CPR) and other life-sustaining treatments.

What Happens if I Don’t Have an Advance Directive?

If you do not have an advance directive, or a legal guardian or agent named a medical power of attorney, then the physician and your closest family member will make your treatment decisions for you. The hospital will give decision-making authority to your family members in this order: (1) your spouse, (2) your adult children, if reasonably available, (3) your parents, and (4) your nearest living relative.

For more information, and for sample forms for you to fill out for your advance directives, please visit the University Hospital website.

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