(This post is brought to you by the Estate Planning & Elder Law Firm, P.C.)
National Healthcare Decisions Day was on April 16th.
In Virginia, the Health Care Decisions Act provides the specifics of the Commonwealths advance directives law. It is estimated, however, that only about 15% of all Virginians have executed an advance directive and less than 50% of severely or terminally ill patients have an advance directive.
One of the primary goals of National Healthcare Decisions Day is to encourage hospitals, nursing homes, assisted living facilities, continuing care retirement communities and hospices to participate in a nationwide effort to provide clear and consistent information to the public about advance directives.
All adults in Virginia have the right to prepare an advance directive in order to put their wishes regarding medical care in writing.
There are two components to the advance directive.
- The first component is the living will. This permits an individual to state what kind of life-prolonging treatment the individual wants or does not want if he or she is in the dying process and the individual is unable to express his or her wishes. Life-prolonging treatment includes using machines, medicines, and other artificial means to help individuals breathe, eat, get fluids into their bodies, have a heartbeat and otherwise stay alive when the body cannot do these things on its own. Medications used to keep an individual comfortable are not considered life-prolonging treatment. Life-prolonging treatment will not help an individual recover. Another way to look at the living will is that if an individual is in the dying process, then the individual does not want artificial means to prolong this process, but the individual might want pain-relieving medications to be administered, even if it accelerates the dying process.
- The other component of the advance directive is often called a power of attorney for healthcare. This allows an individual to appoint an agent or agents to make medical decisions for the individual if the individual becomes incapable of making medical decisions. The document can specifically tell the agent what kind of care the individual does or does not want. For example, the document can give the agent the authority to work with a physician in order for the physician to enter a do not resuscitate order (DNR) on the individuals behalf, but the advance directive itself is not as a DNR order. The agent can only make medical decisions if the individuals physician and another physician or licensed clinical psychologist examine the individual and determine in writing that the individual cannot make medical decisions for himself or herself. As soon as the individual is capable of making medical decisions again, the decision-making authority of the agent ceases.
It is important for people to put their wishes in writing because oral advance directives can be created only if an individual has a terminal condition and can tell his or her wishes directly to his or her physician. Unfortunately, many terminally ill individuals may no longer be competent to discuss their wishes with their physicians. Putting the wishes in writing reduces confusion about the patients desires and it also establishes clear lines of authority for decision-making. This is important for blended families in which there may be second spouses and adult children from prior marriages and for younger couples where conflicts can arise between parents and spouses. Everyone 18 years of age or over should sign an advance directive; it is not just for the elderly.
Anyone 18 years of age or older can be named as an agent in an advance directive; the agent does not have to be a Virginia resident. An alternate agent should be named in case the primary agent is unavailable to serve. Advance directives must be witnessed by two individuals 18 years of age or older; the agents should not witness the document. Advance directives do not need to be notarized; however, the advance directives that The Estate Planning & Elder Law Firm, P.C. prepares for its clients are notarized in case these advance directives need to be used in other states. Although a Virginia advance directive is designed to be valid in any state, an individual who spends a considerable amount of time in another state should prepare an advance directive for the other state. Advance directives can also be registered with the U.S. Living Will Registry or Docubank.
Copies of an advance directive are valid. For this reason, The Estate Planning & Elder Law Firm, P.C. recommends that its clients do the following:
- Keep their original advance directives in a secure place and let their agents know where these advance medical directive are located.
- Give copies of their advance directives to their primary care physicians and all specialists.
- Give copies to each agent and discuss their wishes with their agents.
- Keep a copy of their advance directives in the glove compartments of their vehicles and place one on the side of their refrigerators.
- Take a copy of the advance directive when traveling.
The Estate Planning & Elder Law Firm, P.C.s advance directive also includes a privacy act waiver, also called a Health Insurance Portability and Accountability Act of 1996 (HIPAA) waiver, which permits the agent to talk immediately with the physicians or review medical records, even if the physicians have not declared the client incapable of making medical decisions. This is helpful for seniors when their children do not know if they need to act as the agent for their parents and the only way they can decide is to talk with the parents physicians.
About the Firm: The Estate Planning & Elder Law Firm, P.C. is an elder law firm. They represent older persons, disabled persons, their families and their advocates. The practice of elder law includes estate planning, estate and trust administration, powers of attorney, advance medical directives, titling of assets and designations of beneficiaries, guardianships, conservatorships and public entitlements such as Medicaid, Medicare, Social Security and SSI, disability planning, income tax planning and preparation, care management, and fiduciary services. For more information, please visit their website.
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