Health Care Decision Day Is April 16

Q: My family keeps pushing me to get a health care proxy. I have a power of attorney; isn’t that the same thing?

A: Great question and just in time for National Health Care Decision Day on April 16.

No, a power of attorney and health care proxy are not the same thing.

A power of attorney (POA) is a legal document giving another person the right to make financial decisions for you in any situation. This POA is a very powerful tool, and be sure the person you appoint is someone you trust absolutely. This POA can sell/dispose of your property without your permission. A POA applies to financial matters only and is only useful in regards to financial transactions.

I am going to approach the health care proxy with a larger answer. I will talk about advanced directives. Advanced directives are those tools that allow you to pre-determine or pre-decide your care.

There are a number of types, and I am going to briefly touch on each and why you might want them. The types I will talk about are: do not resuscitate order (DNR), health care proxy (HCP), living will and medical orders for life sustaining treatment (MOLST).

A do not resuscitate order (DNR) is an actual medical order given by your attending physician which states that in a situation where your breath has stopped and your heart has stopped, those who respond will not administer cardio pulmonary resuscitation (CPR) for the purpose of restarting your breathing or heart. There are two types: a hospital DNR (which is only valid while in the hospital) and a non-hospital DNR (which covers all other locations). As I noted, this is a physician order, so it is a document that is signed by your physician, not by you. You request it, but your physician enacts it.

If you have a non-hospital DNR, be sure to display it prominently in your home. If it is tucked away in a file cabinet, the emergency medical staff will attempt to resuscitate you. They must see the actual document. They cannot take your family’s/caregiver’s word.

A health care proxy (HCP) is a document used to designate an individual or individuals to make medical decisions in the event you are not able to communicate your decisions. There are a number of versions of this document available. Most hospitals, medical offices and attorneys have copies they can get to you. You can also get versions online, but be sure it is a version accepted in New York state.

In New York, a health care proxy can be completed and signed by anyone over 18 years of age. When ready to sign this document, have two individuals who are not related to you, like a neighbor or classmate or people sitting at the next table in the restaurant, sign as witnesses. This witnessing of your signature is simply to state that you didn’t sign the document under duress and you were aware of what you were signing.

Once signed and witnessed by two adults, this is a legal document. The HCP does not give those you appoint the right to override your wishes for medical care. The HCP gives them the right to make decisions when you cannot communicate your wishes. It is assumed that you will inform the appointed individuals that they have been appointed as your HCP and you should communicate your wishes clearly to them.

Most forms have instructions along with them, so that you can fill it out properly. There is information that must be explicitly indicated on the HCP form in order for your appointed proxies to be allowed to make decisions.

The next item is the living will. In many states the living will is a legally binding document. In New York is it is considered a supportive document. It gives the physician and your family some indication about how you feel about particular medical procedures and treatments. Your HCP can use the living will to help guide their decision-making process on your behalf. Your physician can help guide your family and appointed proxy in making medical decisions to follow your living will and the expressed wishes it contains.

The living will can be thought of as a narrative of your medical wishes and desires. It doesn’t need to follow a particular format or form, but there are templates available to help guide you through the process.

The last type of advance directive I will cover is the medical orders for life sustaining treatment (MOLST). In New York, the MOLST is a legally binding document that applies across all health care settings. A MOLST form is advisable for people who are seriously ill, who might be in the last year of their lives or have particularly strong health care wishes. This is a four-page, bright pink document that includes medical orders from your physician and the previously reviewed advanced directives. This is signed and renewed by your primary care physician regularly. This MOLST form is a set of orders and directives that are transferable from facility to facility and setting to setting. This is ideal for an individual who is frequently hospitalized, or in a skilled nursing facility. Discuss with your physician whether an MOLST is appropriate for you. The MOLST is not appropriate for everyone and every situation.

A source I commonly refer people to and ask questions of myself is the Chautauqua County Health Network (CCHN) in Jamestown. CCHN is also a source for some of these documents, the MOLST and health care proxy. CCHN contact information is 338-0010, or 200 Harrison St., Jamestown. CCHN also has a health care proxy registry. This is an actual online registry of your health care proxy. This allows medical emergency responders, medical staff and hospitals access to these documents. This is a useful idea, as we don’t always have this information on us when we are ill or in an accident.

Once these documents are completed, I would recommend giving a copy of all these completed forms to your family and medical practitioners. You can’t expect that individuals and physicians make good decisions on your behalf if you don’t inform them of what you want done.

As I stated earlier, advanced directives do not include power of attorney (POA). A POA is a financial tool that you can use to give someone you trust the ability to pay bills, and handle all types of financial transactions on your behalf. POA has nothing to do with health care, unless it is writing a check to pay a medical bill.

I would say that everyone age of 18 or older have at least a health care proxy completed. This allows for medical decisions to be made if you cannot communicate. Say you are unconscious, in a coma or during surgery; it allows for the person you designate to make decisions guided by information you have communicated to them. It puts the decision-making power of your health care in your hands.

We never know when an accident or medical emergency will take place. This small amount of pre-planning and communication allows you to be in charge, whether you can actually speak or not.

The National Health Care Decision Day, as I stated, is April 16. On this day a number of organizations and agencies within our county will be out and about in the community talking about and helping complete these advance directives. Watch for those events and take advantage of the expertise available. Complete or update your advance directives. Your care depends on it.

If you would like to reach Janell Sluga directly with questions, please call 720-9797 or email her at janells@lutheran-jamestown.org.