Legal Health Documents-by Shannon Trezza

No one likes to have the conversation about what will happen if they become seriously ill or injured. However, planning for these possibilities, though it may be difficult, helps your loved ones deal with the challenges they might face should you become incapacitated.

A study published in the Journal of the American Medical Association (JAMA) in February 2013 looked at patterns of end of life care that shed some light on why legal health documents may be an important part of your legal planning and preparation. This study was conducted to look deeper into some of the statistics released by the Centers for Disease Control (CDC). The CDC had reported that greater numbers of people die at home. The presumption is that this results in a higher quality of death than if someone died in a hospital. In fact, Medicare looks at site of death as a quality measure.

From 2000 to 2009 the proportion of deaths in hospitals went from 32.6% to 24.6%. However, use of the intensive care unit did not fall proportionally. In fact, ICU care increased during this time period from 24.3% to 29.2%. Although hospice use increased from 21.6% to 42.2%, over a quarter of these patients were only in hospice for 3 days. Over 40% of the people who were referred to hospice within the last 3 days of their lives, had been in the ICU.

Hospice care is designed to help people die with peace, dignity, and comfort. People receiving hospice care are referred when it is expected they will live 6 months or less. One might conclude that where a person dies tells something about the quality of their experience and the support they receive. However, according to the study published in JAMA, where someone dies is only a small part of the picture when assessing quality.

What does this mean for you? As medical technology has advanced, doctors and health care professionals often have the ability to prolong the life of seriously ill and incapacitated individuals. When a loved one is no longer able to make their own health care decisions, family members are left to deal with making decisions while under extreme emotional stress. If the family member who is ill or injured has not made their wishes know to their next of kin, it is possible for there to be no guidance for the person left to make these decisions. It might also be that there is a conflict within the family about the best course of action or who should make those decisions.

Preparing legal documents that address what you want to happen in case you are unable to make these decisions yourself relieves your family of the burden of making decisions that would be difficult at best and at worst, would be decisions that are the opposite of what you want.

There are legal documents you can fill out that will express your wishes about health care in case you are unable to let others know those decisions after falling ill or being injured. These documents can give guidance to doctors, hospitals and loved ones. You can also appoint a person who will be your agent to make decisions for you.

Living Will
The living will is also referred to as an advance directive. As medical technology advanced through the second half of the 20th century, families faced difficult medical decisions in the face of serious illness and incapacity. The concept of the living will first appeared in the late 1960’s. In 1976, California became the first state to legally recognize the living will.

The Arizona Attorney General’s Office describes the living will as follows.
“A Living Will is a written statement that expresses your wishes about medical treatment that would delay death from a terminal condition. It also applies to situations of persistent vegetative state or irreversible coma. A Living Will would speak for you in the event that you were unable to communicate. It gives direction and guidance to others.”

Health Care Power of Attorney
The health care power of attorney is a legal document that lets you choose an “agent” (another person) who will make health care decisions if you can no longer make those decisions for yourself. You have the option to set specific limits on the types of decisions your agent can make or you can give the person broad authority to make any health care decisions you would normally make for yourself. For example, your agent could make decisions about whether or not to continue tube feeding.

Many people wonder about the difference between the living will and the health care power of attorney. While the living will speaks for you if you are not able to communicate, according to the Arizona Attorney General’s Office a living will “…is not as broadly applicable as a Durable Health Care Power of Attorney. For example, a Living Will does not permit health care providers to stop tube feeding – only an agent appointed by a Durable Health Care Power of Attorney or a court-appointed guardian may make such a decision.”

If you have both a living will and a health care power of attorney, the Arizona Attorney General’s Office states that you should attach your living will to your health care power of attorney.

Durable Power of Attorney
A third document that many people also create to deal with possible incapacity is a durable power of attorney. This document is designed to allow the person you choose as an “agent” to make any financial decisions or conduct financial transactions if you become seriously ill and/or incapacitated.

Electronic Advance Directive Registry
Arizona also has an electronic advance directive registry. This registry allows you to electronically store your legal medical documents so that they are available on-line 24-7. The process for registering your advance directive documents starts with filling out the registration application. You submit copies of your documents by mail. You then receive a form confirming the information. You complete that form and send it back. Once confirmation is received by the Arizona Secretary of State, your registration is activated.

You will have a wallet card with your file number and password that you can keep with you so that any hospital or doctor can get electronic access to your advance directives.
The Secretary of State’s Office recommends that you share this information not only with your medical care team, but also with the person named as an agent in your health care power of attorney.

As certified legal document preparers, the staff at Arizona Statewide Paralegal make the process as simple and efficient as possible. You can even start your living will, health care power of attorney, and durable power of attorney on-line. Once you’ve completed the forms, we prepare the documents and you choose how you want the documents delivered to you. We have the option to e-mail, mail, or provide in-office signing of the documents. We have four locations throughout the Tucson and Phoenix metro areas.

It is never too early to begin making decisions about your health care in the case of a serious illness or accident. As long as you are 18 years of age, you can indicate your health care wishes in a living will and designate an agent should you not be able to make health care decisions. Contact us today to start the process.

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