Monday, July 18, 2011
The Oregon Advance Directive, Health Care Power of Attorney, Living Will or whatever else it gets called.
In law, names change with the times, but the documents stay the same. What was once a living will became a health care power of attorney and has now become an advance directive. The Oregon document is called an advance directive and the form of the document was dictated by the legislature. The form does two things: (1) it names a person to make health care decisions for you if you cannot make them yourself; (2) it gives your doctor directions as to what sorts of treatment you want in circumstances where you are unable to give those directions yourself. Like any legal document, the devil is in the details.
I buy the Oregon advance directive forms in batches of a hundred from a local publisher and hand them out like candy. I am not the only one doing this. Hospitals buy them from the same publisher and hand them out as freely as I do. We give them away for free because we believe that everyone should have one.
Lets' take a look at what the advance directive does. You can take a look at and download the Oregon form here. The form contains three parts, aptly labeled part A, part B, and part C. Part A contains directions for filling out the form and a warning that no one can make you fill it out. Some political groups fear that the advance directive will make it easier for hospital employees to kill old people, thus the first part contains warnings, explanations, and assurances. I am not too worried about this stuff. If worry about evil nurses killing old people keeps you up at night, read part A carefully.
Part B nominates a person to make health care decisions for you if you cannot make them yourself. You fill out your personal information and then nominate a primary and secondary person to act for you in health care matters if you are in a coma and can't communicate your wishes. The person you nominate will be the person the doctors look to when it comes time to decide whether or not to pull the plug on your life support system. This person also has the right to put you in the mental ward for up to fourteen days if you are suffering from dementia and have turned dangerous to yourself or others.
I think that everyone should fill out part B of the Oregon advance directive. Name your spouse, a reliable child, or a good friend. Then talk to that person so he or she knows your attitude about end-of-life care.
Part C gives instructions to your doctor about specific procedures that you may or may not want. Most of the questions deal with tube feeding and life support. I only have the vaguest idea about what constitutes life support and I know nothing about tube feeding. Besides that, my sister is a doctor, and I am not convinced that doctors ever take directions. When I did my advance directive, I left Part C blank. If you are interested in things like tube feeding and have a doctor that might actually consider your wishes, then by all means go ahead and fill out Part C.
The point is that you can fill our Part B, or Par C or both, but you don't have to fill out both.
Once you have filled out the form you need to sign it in front of witnesses. If you filled out Part B, sign at the end of Part B. If you filled out Part C, sign at the end of Part C. If you filled out both, sign both. You need two witnesses to your signature. For the first witness anyone will work except your doctor and the person you named to be your health care representative in Part B. For the second witness, you must find someone (1) who is not related to you by blood, marriage or adoption; (2) who is not entitled to any of your estate after you die, and (3) is not employed by a health care facility where you are residing. Use a next door neighbor, the mailman, or the legal assistant in my office.
Once you have filled out the advance directive and had it witnessed, you keep if for the next time you go to the hospital. When you go, take it along. They will ask if you have one and will be ready to take a picture of the original to put in your medical file. Then if you go under the knife and it doesn't work out, the hospital can look at the advance directive for contact information of the person allowed to make decisions for you.