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Advance Health Care Directives And Living Wills: A Step-By-Step Guide
Posted by | Posted in Health | Posted on 20-09-2010
Few decisions are more personal — involving both health and death — than those embodied in an advance health care directive or a living will, or a similar document. Some individuals want their lives prolonged by any means necessary, while others want medical treatments withheld, allowing for a natural death.
An advance health care directive lets caregivers and family and medical providers know a person’s healthcare wishes if he’s unable to speak for himself. The document can also appoint someone else to speak with legal authority for the person if he’s unable to do so for himself.
If someone plans to set up an advance health care directive, living will, or similar document, here’s what he needs to think about:
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1. The person should consider how he wants to live during a terminal illness, and what his end-of-life preferences are when creating a health care directive or living will.
It’s not easy to bring up the subject of dying (especially if it’s your parent you’re caring for). But you, the individual, and the rest of his family will gain some peace of mind if you can get him to start thinking and talking about this subject, and eventually to execute documents that set down his wishes.
·One way many people get this discussion started is by showing the person the advance health care documents they’ve prepared for themselves. This both breaks the ice and gives the person a model on which to base his own documents.
·The job is to get him thinking about what will be important to him when he is incapacitated, and particularly when he’s dying, such as where he wants to be — at home if possible, or in a hospital — and what treatments (particularly life-prolonging ones) he wants and doesn’t want.
·He also needs to think about who he wants to make decisions for him if and when he’s unable to do so himself.
·The person should discuss these things with family, healthcare providers, and trusted advisors who will help him consider his wishes, options, and fears.
·But remember that a conversation doesn’t have the same legal force as an advance health care directive or similar written document, even if a doctor records it. In most states, only a written, signed, and witnessed advance health care directive legally must be followed by healthcare personnel and institutions.
2. The person should carefully consider whom he wants to serve as the agent to make decisions for him and support his choices when creating a health care directive or living will.
The agent the person in your care names in his advance health care directive should have several qualifications:
·The job can be emotionally difficult, so it should go to someone who cares deeply about his welfare.
·It should also be someone who is likely to be able to remain physically near him during a prolonged healthcare crisis.
·And it should be someone who has a strong enough personality to stand up to family members, doctors, and hospital personnel if necessary.
·Sometimes a trusted friend will make more objective decisions, or will follow the person’s wishes more carefully, than a family member.
Whomever he winds up choosing, he has to discuss the responsibility with that person and make sure she’s willing to accept it before naming her in the document.
3. Use sample forms for the advance health care directive or living will as planning tools.
Situations to address
Each individual’s advance health care directive should be personalized to reflect his particular wishes. An advance health care directive should address situations such as:
·When (if ever) the person in your care would want artificial life-sustaining treatment, such as during permanent unconsciousness or severe dementia
·Types of life-sustaining treatment he would and would not want, such as artificial nutrition and hydration, surgical procedures, and cardiopulmonary resuscitation (CPR) — and under what conditions
·Instructions about other medical procedures that may arise given the person’s medical history
·Organ donation instructions
·Pain control preferences
·Where he wants his care (at home or at a designated nursing facility, for example)
Documents available online
Generic advance health care document forms are available from many sources, but the forms are designed to be planning tools only. They don’t offer a final product — the forms are meant to trigger but not replace communication between the person in your care (the principal) and the designated decision maker (the agent).
Still, they are useful for getting started. Most state legislatures provide official forms for advance health care directives and living wills. These examples, among others, are available online:
· New York
· California
· Delaware
· Illinois
· Oregon
· Massachusetts
Similar forms are provided by such groups as state medical and bar associations. For example, sample forms can be found online through the California Medical Association, AARP, and the American Medical Association.
The importance of state forms
·Though there’s no single form that must be used for an advance health care directive, an individual should use his state’s standard form if it has one. He should also follow his state’s signature and witness requirements. For example, most states require two witnesses to the person’s signature; some states also require notarizing the document.
·In most states, witnesses cannot include relatives, heirs, medical providers or their employees, or anyone responsible for the patient’s healthcare costs. If the person in your care is in a nursing home, some states require a state nursing home ombudsman or patient advocate to witness the signing.
·Once the document is executed, the individual should give copies to his doctors and hospital, the person he designates as his healthcare agent, family members, and other advisors. He should keep a list of individuals and institutions that have a copy of the advance health care directive, in case he ever wants to revoke or change it.
4. Update the advance health care directive or living will based on changing end-of-life wishes.
·Encourage the person you’re caring for to revisit his advance health care directive periodically, as long as he’s able to do so. His feelings and choices may evolve as his situation changes — for example, after he’s diagnosed with a serious illness, or as he witnesses others going through the end of life.
·People commonly make changes right before a major surgery. He may also change his feelings about who should act as his healthcare agent, or his original choice might no longer be able to take on the job.
·He can terminate or change the advance health care directive as long as he has the mental capacity to do so. If he wants to make a change, he should prepare and sign a new document and have it properly witnessed again; just making handwritten changes on a previous document is not a good idea.
·If he does execute a new document, he should send a copy to every person and institution that has a copy of the previous one, explaining that the new one replaces the old. In most cases, completing a new advance health care directive automatically revokes all previous directives, but it’s always a good idea to let everyone know personally.
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Help answer the question about health care
health care?if my cousin(canadian) marries her american bf will she lose her health care coverage here permanently? and how would marriage affect her canadian status?
a long distance relationship is difficult but before she agrees to move there she wants to know how her canadian health care would be affected. The other option is for him to move here, but he has strong family ties. So..say she starts with a temporary work visa.. what are the guidelines in regards to coverage? *we canadians hear such horror stories about U.S citizens not having enough money to get needed medical assistance*
First of all health care is a provincial responsibility so it depends on the rules of her province. In Ontario she has to reside in ON for at least half the year to be covered by the ON health plan. It would be prudent to check this out.
Marriage would not affect her citizenship.
Okay if you won't have any clinical skills or any managerial/administration skills, just what will you do? You'll have a lot of knowledge but nothing to do with it.
Yes. If you have unlimited resources as an American you have the best health care in the world. If you are an ordinary citizen you simply don't. Even the average health care plan generally does not cover the basics like European systems do. All too often Americans find out just how under insured they are when sickness strikes.
http://www.commonwealthfund.org/Content/Publications/In-the-Literature/2008/Jun/How-Many-Are-Underinsured–Trends-Among-U-S–Adults–2003-and-2007.aspx
That's important because when those people are lucky enough to stay healthy they will never see a problem whatsoever just as their fellow countrymen were just fine with their coverage before tradgedy happened.
http://www.click2houston.com/investigates/12538706/detail.html
http://www.guaranteedhealthcare.org/your_story/my-insurance-company-denied-my-doctors-prescription
http://www.rhonawaxman.com/blog/insurance-company-medical-exam-denied-me-surgery.html
This is the same thing as with the standard of living. Americans have a higher income on average than Americans but more detailed data shows it's the top 1 percent income earners that's responsible for the whole difference. Middle clas an poor Americans are much worse of than their European counterparts
That's ultimately what it is about
Depends on the perspective. The "socialized" (please use in quotation marks) perspective is that users of health care are the community as a whole; thus, 'just' is defined as minimizing the losing individuals. "Free market's" views are that the users are individuals or groups of individuals; thus, 'just' is defined as maximizing the number of individuals 'satisfied.'
From both common political and ethical perspective, a child is often unable to contribute to the discussion of 'individuals to be lost' in "socialized health care" or 'user satisfaction' in the "free market." Given the assumptions that pediatric care is satisfactory for most children, "socialized health care" is more just because the intrinsic cost-of-life-saved would then be higher even though some children would fall through the cracks. HOWEVER, given the assumption above and also that the income difference between the richest and poorest people is minimal, the "free market" is more just because parents can decide what is most 'satisfactory' without too much undue financial burden.
what is the future of health care?
what diseases do we need to be aware of?
how do i stay healthy?
where do i turn if a loved one is diagnosed with a serious illness?
First off, illegal aliens are not immigrants. Immigrants follow laws. They get free health care by not paying bills when going to emergency rooms, giving false names and addresses etc… It also cost American taxpayers over $6000.00 per birth for each anchor baby born. That is if there are no complications.
In a recent year in Colorado, the state's emergency Medicaid program paid an estimated $30 million in hospital and physician delivery costs for about 6,000 illegal immigrant mothers – average of $5,000 per baby. Those 6,000 births to illegal aliens represent 40% of the births paid for by Medicaid in Colorado. Those 6,000 babies immediately became U.S. citizens and qualified for full Medicaid services, with a cost yet to be tabulated.
The federal Emergency Medical Treatment and Active Labor Act (EMTALA) mandates that U.S. hospitals with emergency-room services must treat anyone who requires care, including illegal aliens. Medical service for Americans in affected communities is being severely damaged as hospitals absorb more than $200 million in unreimbursed costs. Some emergency rooms have shut down because they cannot afford to stay open. Local tax-paying Americans are either denied medical care or have to wait in long lines for service as the illegals flood the facilities. In California, the losses are calculated to be about $79 million, with $74 million in Texas, $31 million in Arizona, and $6 million in New Mexico.
These costs are staggering. The Cochise County, Arizona Health Department spends as much as 30 percent of its annual $9 million budget on illegal aliens. The Copper Queen Hospital in Bisbee, Arizona, has spent $200,000 in uncompensated services out of a net operating budget of $300,000. The University Medical Center in Tucson may lose as much as $10 million and the Good Samaritan Regional Medical Center, also in Tucson, has lost $1 million in the first quarter of fiscal 2002.
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ILLEGAL IMMIGRATION HEALTHCARE COSTS AFFECT YOU!
Published 06/01/2010 – CST By Elizabeth Lee Vliet, M.D.
In both Tucson and Dallas where I have practiced medicine, hospitals are struggling under massive costs of uncompensatedmedical services for uninsured people who, by federal law, cannot be turned away for lack of insurance or ability to pay.
How much does this uncompensated care actually cost taxpayers? The incredible answer: no one knows.
We only have “estimates” of the costs to taxpayers to treat illegal immigrants because hospitals and public health clinics do not ask for proof of citizenship before providing care.
What are consequences to taxpaying citizens?
1. Increased cost and reduced access to trauma care. Tucson has lost all but one Level I Trauma Center to serve all of southern Arizona, in large part due to massive, unsustainable losses from uncompensated care. Auto accidents involving overloaded vans of illegal aliens happen regularly in southern Arizona. Injured are flown by air ambulance to University Medical Center’s Trauma Center and treated with state of the art care….all at taxpayer expense.
2. A registered nurse involved with the Pima County health system since the 1970’s who must remain anonymous because of her role, said she has never seen any staff member at either El Rio Clinic or Pima County Health Department ask for proof of citizenship before providing free medical services (immunizations, Well Baby checks, food stamps, WIC services, birth control, and even elective abortions). Costs are paid by taxpayers. When funds are depleted, low income American citizens have fewer services and longer waits as a result.
3. This same RN also said: “I personally know Mexican men who married 16 year old girls, got them pregnant, brought them to Tucson for the baby to become a US citizen. They livein Mexico but come here for their health care. Taxpayers pay for this medical care many ways, at the Public Health Department, and with school nurses who provide care.”
4. Uncompensated medical services for illegal immigrants mean higher premiums for all of us due to cost shifting among all third party payers. To cover the deficits from “free” medical services they provide, the administration at University Physicians Health System Kino campus is analyzing how much to increase employeehealth insurance premiums as of July 1.
5. Obamacare cuts benefits to American citizens: $500 billion in Medicare cuts and slashing the Medicare Advantage program. Medicare Advantage, chosen by one in five seniors, is the most popular plan for low and moderate income seniors, and covers about half of our Hispanic or African-American elderly. My patients on Medicare have worked and paid into the system over their working careers, yet these cuts mean less healthcare available to them now. We certainly cannot afford to cover those here illegally.
6. Hospitals in Tucson and Dallas also provide uncompensated (“free”) maternity services to pregnant women here illegally. Their babies then become US citizens entitled to all of the services available for low income American families – food stamps, WIC, immunizations, office visits, medications, etc. This drives up costs to all of us: higher premiums for private insurance companies, and higher taxes for government insurance like Arizona’s Medicaid (AHCCCS).
7. Professional estimates are that over halfof the pregnant women served at Parkland Hospital in Dallas are in this country illegally. With over 16,000 deliveries a year, Parkland is one of the nation’s busiest maternity services with prenatal clinics for low income women to receive free prenatal care, nutrition, medication, birthing classes, child care classes, and free supplies (formula, diapers, bottles, car seats). Taxpayers pay the bills.
I'm from California & I'm not sure about your question, but I'll say some stuff I know. Half of my relatives are in Canada & although I'm poor, several of my Canadian Uncles, Cousins, etc., are doing quite well financially. Every one of them LOVE the health care in Canada & look with disgust at the USA. Health care in America is much more expensive & less available because it is a FOR PROFIT industry. Drugs are extremely overpriced & the insurance companies care about your health as much as they care about the stuff they just expelled into their toilets. They will DENY you coverage on anything. All they need to do is find an excuse to drop you, that is, when you make a claim. They've got the most educated lawyers who do nothing but try to save the Insurance companies money. We are the most backward "First World" country on this planet morally in regards to caring about it's own citizens. Here is a site to look into. & there are many more on the internet. http://www.pnhp.org/facts/singlepayer_faq.php If you're mostly concerned about Canada's situation, keep looking on the web. I'm sure you'll find something. And remember, insurance companies are only concerned with profit!
They have a 100 percent covered plan for them and their families for life (assuming they serve at least 6 years), along with an excellent pension plan for life.
They will care about the crisis if it is something the voters want! After all, if they are not acting in the interest of the voters, they will lose their seat and their health care plan.
Unfortunately, there is so much disagreement between the "left" and the "right" that it is difficult for congress to do anything. In addition, many people (even those who truly need health care reforms) vote based on moral values, leaving health care to be ignored.
What is going to happen is the Government is going to set the rates doctors can charge for services. Doctors cannot afford the rates so they will overbook people to get the most money they can so you will go to the Dr office and wait for several hours and maybe even have to return the next day. Dr groups will get bigger and overbooking will be even more and waiting will be longer. Just think of going to the Dr and there being 100 patients in the waiting room to see a Dr.