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Planning for the End of Life: Advance Directives Utah law provides several ways to convey your wishes to medical providers if you are unable to do so. The law provides four separate documents that you should complete to communicate your wishes about medical treatment to loved ones and healthcare providers. These four documents are: (1)Living Will, (2) Medical Treatment Plan, (3) Special Power of Attorney for Healthcare, and (4) EMS/DNR Directive. As long as you are able to make decisions for yourself, you do not need a living will to provide instructions to your healthcare providers about your own end-of-life care. You do not need a living will to tell your doctor that you do not want life-sustaining treatments if you can tell her yourself; your direct instructions to your healthcare providers should be honored by your doctor. But if you are unable to make decisions for yourself, advance directives can help to communicate your wishes about what you want and about who you want to make decisions for you to your healthcare providers. While the focus of this discussion is on the legal requirements, it is impossible to stress too much the importance of communication. If you have preferences about end-of-life care, you must communicate these preferences to your physician, your healthcare proxy, and your family. These are the people who will make decisions about your healthcare if you are not able to do so. If they do not know your preferences, they cannot carry out your wishes, which may render the advance directives that you prepare useless. One final note on the limitations of advance directives: as noted above, these documents come into play only if you are unable to make or communicate decisions for yourself. If you are of sound mind, you have the legal right to state your preferences to your care provider and your preferences should be honored, whether or not you have completed a living will or medical treatment plan. The specific forms are discussed below. After you fill out any of advance directive forms, you should provide copies and discuss your wishes with the following people: (1) the person who holds the Special Power of Attorney for Healthcare, (2) family members, and (3) your physician. Copies should also be provided to the hospital where you are likely to receive treatment. You should keep the original documents in a safe place that can be accessed by others who will be making your healthcare decisions for you if you are unable to make them yourself. a. Living Will In Utah, a Living Will allows you to indicate in writing what care you wish to receive if you have or develop a terminal condition or if you fall into a persistent vegetative state and cannot make decisions. If you have signed a Special Power of Attorney for Healthcare and the healthcare proxy disagrees with the wishes expressed in the living will, the physicians must do what the healthcare proxy directs. Utah law defines a terminal condition as an incurable or irreversible condition for which continuing medical treatment would not improve health, but would only prolong the dying process. A persistent vegetative state is a severe impairment of mental functions that prevents thought. You are in a persistent vegetative state when you are comatose with no higher cognitive function; your body performs only involuntary bodily functions. A Living Will must be signed by two witnesses who: (1) are 18 years of age or older; (2) are not related to you; (3) will not inherit from you; (4) are not financially responsible for your care; and (5) are not agents of the health care facility in which you are a patient when you sign the living will. The Tool Kit for Advance Care Planning, which was developed by the American Bar Association, is available from the Partnership. The Tool Kit asks specific questions about conditions, your philosophy of life, preferences, and other facts that your family and the holder of your Special Power of Attorney for Healthcare can use to determine your wishes if they have to make decisions for you. Call (801) 892-6635 to obtain a copy of the Tool Kit or you can download the Tool Kit by clicking here. As discussed below, the living will can be revoked or reversed by you at any time. Click here for the printable living will form. b. Special Power of Attorney for Healthcare A Special Power of Attorney is a written statement that gives legal authority to another person to make healthcare decisions for you if you cannot make your own decisions due to an illness or injury. This person is called a "health care proxy." You can identify the person you want to make your healthcare decisions by using a Special Power of Attorney form. The form must be signed before a notary public. You should think about the following when choosing
who will make your healthcare decisions when you cannot: (1) choose someone
who knows you well, cares
about you, and can make difficult decisions; (2) choose someone who will
stand up for you; (3) choose someone who is physically close enough to
act on
your behalf. The person you use
does not have to be related to you. Finally,
you should discuss what you want with your chosen proxy and be sure that he
or she is willing to respect and follow your wishes. Click here for the Special Power of Attorney for Healthcare Form c. Medical Treatment Plan A Medical Treatment Plan, also referred to as a "Directive for Medical Services After Injury or Illness," allows you or your proxy and your physician to record a plan for care that is binding on physicians and other medical care providers. The Medical Treatment Plan is completed only after you already have a serious illness or disease, or if you are considering an operation or other medical procedure that could result in substantial impairment or death. The law specifically permits Medical Treatment Plans for those over 18 years of age. If you are unable to work with your physician to complete a Medical Treatment Plan, the law establishes who has the authority to complete the form with your physician: (1) the person named on the Special Power of Attorney; (2) a legal guardian; (3) spouse; (4) parent; (5) child (if 18 years of age or older); (6) the nearest available adult relative; or (7) a person designated by you to sign the Medical Treatment Plan. Click here for a printable Medical Treatment Plan Form d. Emergency Medical Services/Do Not Resuscitate Directive The Emergency Medical Services/Do Not Resuscitate Directive (EMS/DNR Directive) provides a quickly identifiable way for a person to declare that EMS personnel may not administer CPR or other techniques and for the EMS personnel to identify the patient as a EMS/DNR declarant. The law, however, requires that specific conditions be met before a patient can obtain a EMS/DNR Directive.
Once issued, the original EMS/DNR Directive should be hung in an unobstructed view above the patient on the wall or in close proximity to the head of the bed. If the patient is mobile, it is highly recommended that he wear the approved bracelet/necklace so that it can be easily recognized by EMS personnel. The patient should inform his family that the directive can be revoked by destroying both the written directive and the bracelet/necklace. Removal of the bracelet will be considered to be destroying it. This can be done by the patient or by his proxy. The patient can also verbally state to the EMS personnel his desire to be resuscitated should he arrest. For more information contact: The
Bureau of Emergency Medical Services e. Revoking or Voiding Advance Directives To revoke an advance directive, you may destroy the old one, write "revoked" across the old one, write a new one, or orally express your desire to revoke it. If you orally revoke the advance directive, you should do so in the presence of an adult witness who should then sign and date a written statement confirming that you have revoked your advance directive.
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