The importance of a health care proxy

Make your wishes known By Alex L. Moschella, Esq. Anybody who watches medical drama shows on television can appreciate the medical miracles being performed in hospitals today. It is comforting to know that physicians and nurses are ready to use a wide variety of treatments to save our lives. But we also want the assurance that, at a time of crisis, those caring for us make their decisions based on our own wishes and desires. Some life sustaining medical procedures (such as the use of respirators, feeding tubes, cardiac resuscitation, DNR orders, etc.) may not be what we want. Treatment preferences often reflect an individual's personal values and religious views. When a person becomes unable to communicate their health care decisions to care providers, however, that individual's treatment preferences may be in jeopardy. A Health Care Proxy - a legal document that gives specific rights and instructions regarding medical care - can help ensure that these preferences are honored in the event a person is unable to make or communicate their health care decisions. The purpose of the Health Care Proxy is to permit you, (known as the Principal) to designate in advance who will make your health care decisions should you become unable to make your own health care decisions. A Health Care Proxy allows you to appoint a health care "Agent." The Agent is permitted to make a wide range of medical decisions on your behalf if you are unable to make or communicate your wishes. The Health Care Proxy may be more or less specific on the decisions you would like your Agent to be able to make for you, depending upon your comfort level. A Health Care Proxy becomes effective when your attending physician determines - in writing -that you are unable to make or communicate health care decisions on your own. If the determination is based on mental illness or developmental disability, the attending physician must consult with a specialist before making a conclusion in regards to the patient's inability to make decisions. Once it has been determined that the patient no longer has the capacity to make their own decisions, then the medical facility will look to the Agent named on the Health Care Proxy to make health care decisions on his or her behalf. Should the patient regain the ability to make informed health decisions (which must also be determined by the physician) then the Agent's authority ceases. The best advice on choosing an Agent is to select an individual that you trust to make significant health care decisions. This trust usually stems from a relationship in which the Agent understands your values and beliefs and respects your feelings in regards to such matters. In choosing an Agent you should also consider the Agent's willingness to follow through on difficult medical decisions. In some situations there may be disagreements among relatives, friends and physicians as to the "proper" course of treatment for you. At these times, the Agent must be able to communicate your wishes to the physician, honoring your expressed wishes. It is impossible to anticipate all of the possible medical situations that may call for an Agent's decision. Certain decisions, however, arise frequently and therefore merit discussion with an Agent. These health care decisions include the use of feeding tubes (food delivered through a tube to a person's stomach) and respirators (breathing machines), treatment options for patients in persistent vegetative states (very deep comas) and comas, and the use of experimental treatments. Another document you may wish to complete ahead of time is a Medical Directive. A Medical Directive is not a binding document like a Health Care Proxy, but is a form that supplies the most likley situations under which an Agent would be needed to make your health care decisions. The Directive supplies the issues and then options that you check off indiciating your wishes. The Directive is signed by the Principal and will serve as a guide for the Agent when making difficult decisions, it may also clear up potential controversies over your wishes that may arise. Some people believe that a "living will" can take the place of a Health Care Proxy. A living will is a document that is triggered only when a physician determines your condition is futile or irreversible. Living wills are currently not recognized under Massachusetts law. If you have a Health Care Proxy, a living will is not required and is simply another form of an advanced directive. A Health Care Proxy and other accompanying documents are extremely important to have in place. Though there are simple forms available at hosptials and nursing homes, more extensive forms and the couseling that goes with them from an elder law attorney is the best way to make sure you are protected, and that your wishes will be honored. Alex Moschella is a partner in the law firm of Moschella & Winston, LLP, which specializes in elder law. It is located at 440 Broadway, Somerville, Mass., 02145. For more information call 617-776-3300 or visit online at www.moschellawinston.com.

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