By Nancy Marie Dowling, Founding Attorney, Solutions Law Group LLC
Deciding what to do in the event of illness or incapacitation is a decision many put off having conversations about. So many, in fact, that a group of healthcare nonprofits, government agencies and businesses across the country have designated April 16, 2018 "National Health Care Decisions Day" to encourage people to speak to their loved ones and get started planning.
In many states, the documents outlining a person's wishes are called "Advance Directives". Here in the Bay State the authority and responsibility to act on a person's behalf is designated by what is called a "Health Care Proxy".
What's a Health Care Proxy?
In Massachusetts, the law allows every competent person over 18 years of age ("principal") to appoint another person (i.e., a "proxy" or "agent") to direct medical providers as to medical decisions when the principal is unable to communicate for him or herself either temporarily or permanently. When you execute a Health Care Proxy, you are appointing the named proxy to make medical decisions for you in accordance with what you would have decided if able to communicate yourself. A medical provider invokes the appointed agent's power when the principal can no longer communicate (or competently communicate) for his or her self.
It is important that you are able to discuss and communicate your wishes clearly with whomever you have selected for this important role. The importance relates not only to conveying your wishes but also to making sure that your proxy feels comfortable and able to carry out your wishes in any variety of situations.
What are Advance Directives?
There are several names for this type of document, including a "living will". A living will is an "advance" statement that provides guidance to providers as to what types of medical treatment you would want or not want should you become unable to communicate. In some states, these documents are legally binding and thus are "directives". In Massachusetts, these documents are not legally binding. In Massachusetts, the proxy's decisions are binding, even if in conflict with such a written statement. Despite this, living wills are useful documents and are often created to provide guidance to those tasked with these critical matters. Such a document can be very useful in a case where a named agent might be concerned that another person might challenge his/her decision on behalf of the principal.
Everyone does not feel the same way about these matters. Most people we've helped wish to refuse medical intervention to prolong life where quality of life is considered lost. This is most often balanced against medical interventions for pain and to provide comfort.
Others want a plan to incorporate their personal feelings and beliefs. Such may range from full medical intervention to some specified point when intervention should be stopped. In determining your own wishes, the following might be considerations:
1. What quality of life is important to you?
2. Will the medical treatment bring a cure, prolong life or serve any other purpose?
3. Will the treatment contribute to comfort?
4. What spiritual, cultural or personal beliefs and values might be important to you?
5. What costs are involved and how will they be met?
6. What effect will the treatment have on your family or others you care about?
7. Anything else that is important to you.
The following are a list of some options.
- I want no medical interventions at all.
- I want comfort measures only to relieve pain and suffering as stated in the standard language listed above.
- I want all possible medical intervention available:
- I want only the following medical interventions _______________________________________________________________________________________________________________________________:
- until I am given the last rights
- until ____ hours/days/weeks after I receive the last rights or the elders of my church have anointed me and prayed for my recovery; with interventions to be discontinued if no or minimal sign of recovery
- for a period of ____________________; with interventions to be discontinued if no or minimal sign of recovery
- Other: _______________________________________
While broaching these topics can be difficult, not doing so could be the difference between having your healthcare and end of life decisions made by someone you trust who knows your wishes or leaving it up to chance. I hope this article can serve as a starting point for conversations and guidelines for things to think through and discuss. As always, we at Solutions Law Group LLC are here to help. Please don't hesitate to contact us at (617)924-0300 if we can be of service.