living will and durable power of attorney for healthcare

Patricia Carroll, RN,BC, CEN, RRT, MS

It’s something people don’t want to think about. But, as an ER nurse, I strongly urge you to talk with your family about what you would want done if you suddenly became critically ill or were in an accident and became unconscious and couldn’t make decisions about your own care.

When anyone comes into the hospital, we must ask if you have "Advance Directives." This refers to two documents: a living will and a durable power of attorney for healthcare (in some places called a healthcare proxy or healthcare surrogate).

Most people are familiar with living wills. A living will states what treatments you do and don’t want if you have a terminal illness, death is imminent, or you are in a permanent coma. The best way to prepare this document is to talk with your personal lawyer who knows you and your family situation. Sometimes a simple document is enough. If your situation is more complicated, you may need more detailed legal papers.

If you cannot afford a lawyer's advice, click here to go to the Web site for Partnership for Caring, an organization that provides boilerplate state-specific documents. (Don’t forget to review the nursesnotebook.com disclaimer )

While most people know about living wills, fewer have heard of this document. In many cases, though, it is even more important than a living will. A durable power of attorney for healthcare (DPA) authorizes the person you want to make decisions about your care if you are unable to make decisions yourself. With this document, you designate someone you trust to carry out your wishes when you are unable to direct your own care (usually because you are unconscious).

Unlike a living will that specifies treatments you do and do not want, a DPA names a person to act on your behalf.

As nurses, we are patient advocates. We want the loved one you prefer to make decisions for you if you can’t. But if you aren’t legally related by blood or marriage, without that special DPA form, we may not be able to help as much as we would like. Almost every nurse I know has been caught in the middle between what we believe the patient and his or her partner or loved one would want done, and what "official" blood relatives may want done. In some cases, blood relatives try to shut the patient’s partner or loved one out. If you live in a domestic partnership, the DPA form is critical so we can follow your wishes and stand up for you and the person you have chosen to make decisions for you.

In some cases, you need a DPA because you have a partner, but you’re not related in the eyes of the law. Or, you may have a family conflict in which a parent may prefer that one offspring rather than another makes decisions. In other cases, a married person may prefer that a parent make decisions instead of an estranged spouse. In my case, I am designated as DPA simply because I am the family member with the most medical experience who will understand medical situations the best. Even if you want your closest legal relative to make decisions on your behalf, it’s a good idea to sign a DPA.

Again, you’ll want to get a durable power of attorney for healthcare from your personal lawyer who knows you and your family situation. As with a living will, it may be a simple form, or you may need something a bit more complex. It’s easiest to get both documents prepared at the same time. If you’re in a domestic partnership, each of you should prepare your own documents together with a lawyer. Keep one copy in a safe place you can get to quickly in an emergency and leave one copy with your lawyer. If there is an emergency and you get called to the hospital, if you can grab the documents on your way, then we can follow your wishes to the letter.

If you cannot afford a lawyer's advice, click here to go to the Web site for Partnership for Caring, an organization that provides boilerplate state-specific documents. (Don’t forget to review the nursesnotebook.com disclaimer )

Please don’t think that Advanced Directives don’t apply to you because you are young and healthy. Accidents and sudden critical illnesses can happen any time. We want to be sure you get the care you want, and that we do not give care you wouldn’t want. If you are unconscious, we want to make sure the person you trust the most makes treatment decisions for you.

Finally, please talk with your loved ones about organ donation. If you are in a tragic accident that results in brain death, you have the power to save someone else’s life. The most unselfish act of all is telling your loved ones you want to donate your organs. I have helped families through this most difficult of decisions, and then hours later, I have worked with the families of the people who received those life-saving organs. Believe me, they are eternally grateful to the donor families.

If you want to be a donor, you must talk about this with your loved ones. Checking a box on your driver’s license it not enough. Your loved ones must say "Yes" or "No" when brain death occurs and they are asked about donation. There is no cost to the donor family, and the donor is not disfigured in any way.

For more information about organ donation, click here . And, thank you.

Written: July 2001

Reviewed: February, 2002, May 2004