Planning ahead: sorting out the medical directives maze Planning ahead: sorting out the medical directives maze (April 13, 2005)

How to make your end-of-life decisions clear

by Stanford Health Library

There is one clear lesson to draw from the Terry Schiavo drama: It is crucial that we make known our wishes regarding end-of-life care and put them in writing. Confronting these life and death issues is difficult at best. An already challenging task, is made overwhelming when you add a confusing array of terms, such as living wills, advance directives, and durable power of attorney, and laws that differ from state to state.

The State of California has attempted to simplify the process, through a form known as the Advance Health Care Directive, a legal tool to make your health care preferences known if for any reason you are not able speak for yourself. The Advance Directive allows you to appoint someone to be your health care agent, a person you would like to make health care decisions for you if you are incapacitated. This agent must be someone other than your physician. In the Advance Directive, you may also specify the type of care you would like to receive, such as the desire to discontinue treatment if you are kept alive on life-support equipment.

The Advance Directive is the legal equivalent of a living will in California. It provides more flexibility than the traditional living will, known as the Natural Death Act Declaration, which typically allows you to refuse life-sustaining treatment only if you are terminally ill or permanently unconscious. With an Advance Care Directive, you can be more specific about receiving or refusing treatment in any situation when you are unable to make your own decisions.

The Advance Directive also replaces the Durable Power of Attorney for Health Care in California. If you have a Durable Power of Attorney, it is still valid as long as it was enacted after 1992. If your Durable Power of Attorney is older, you will need an Advance Directive.

An "Advance Health Care Directive Kit" is available for $5 from the California Medical Association (http://www.cmanet.org). The kit includes an Advance Care Directive form, wallet cards and a packet of information including frequently asked questions. Advance Care Directive forms are also available from the Stanford Health Library at no charge. Free forms can also be downloaded from the Internet at http://www.calhealth.org. If you type Advance Health Care Directive into the search tool window, you will be taken directly to the forms which can be printed out.

To ensure that your health care wishes are carried out, it is crucial to discuss your Advance Care Directive with your physicians and loved ones, particularly your designated health care agent. Sometimes this is the most difficult part. You should explain your personal values clearly, explaining what makes life meaningful to you, your concerns about death and dying, and your feelings about aggressive treatment or life support.

Resources are available to help you sort out your thoughts and feelings on these subjects. At the Stanford Health Library, helpful books include: Staying in Charge: Practical Plans for the End of Your Life, by Karen Orloff Kaplan, M.P.H., Sc.D. and Christopher Lukas; and Handbook for Mortals: Guidance for People Facing Serious Illness, by Joanne Lynn, M.D. and Joan Harrold, M.D. The Stanford Health Library Web site contains extensive links to helpful end-of-life information, covering financial, medical and long-term care considerations, on the Internet (http://healthlibrary.stanford.edu/resources/internet/bodysystems/senior_decisions.html).

For more information or assistance, come into one of the Stanford Health Library branches, at the Stanford Shopping Center near Bloomingdales'; on the third floor of Stanford Hospital or on the main level of Stanford's new Cancer Center; or call (650) 725-8400.

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