Description of Advance Directives, Living Wills, & Code Status

By Chris Blank

Headline-grabbing circumstances such as the case of Terri Schiavo, who spent more than a decade in a vegetative state, illustrate the complications that can arise when there are no clear instructions in place concerning catastrophic illness or end-of-life care. Advance directives, code status and living wills are three instruments that can provide guidance to your family and to medical professionals about your medical treatment. Having these kinds of instructions in place can provide direction for your medical care if you should become incapacitated.

Headline-grabbing circumstances such as the case of Terri Schiavo, who spent more than a decade in a vegetative state, illustrate the complications that can arise when there are no clear instructions in place concerning catastrophic illness or end-of-life care. Advance directives, code status and living wills are three instruments that can provide guidance to your family and to medical professionals about your medical treatment. Having these kinds of instructions in place can provide direction for your medical care if you should become incapacitated.

Legalities of End-of-Life Care

Without clear instructions in place, hospital policy and medical opinion of the physician govern the course of treatment of life-threatening illness or injury. In many cases, these policies and treatments go against what the patient would have authorized had she been mentally competent. In other cases, unless a patient has made her wishes known in advance, hospitals and other medical providers are bound by the law to continue to administer treatment, even when the indications are strong that the patient's chances of eventual recovery are small or nonexistent. Disputes among family members concerning what the ill person would have wanted often erupt, and are frequently only settled after contentious legal action.

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Advance Directives

Advance directives are documents that provide specific instructions for medical care professionals and facilities concerning your wishes that take effect if you should become incapacitated. A medical directive describes the type of care you wish to receive for life-threatening illness or injury, including medications and surgery. A health care proxy, which is similar to a durable power of attorney for health care, assigns the authority to a trusted person such as a family member or a friend to convey your wishes. You must draft a medical directive and assign a health care proxy while you are mentally competent.

Living Wills

A living will is a type of advance directive that deals specifically with whether to administer or withhold life support or heroic medical intervention in the event that you become terminally ill or suffer an injury with no reasonable chance of recovery. A living will addresses issues such as whether to administer or withhold artificial feeding, anesthesia, cardiopulmonary resuscitation, or CPR and life support. Living wills are legally binding documents in 42 states and the District of Columbia. In the remaining states, a living will represents concrete evidence of a patient's wishes.

Code Status

Hospitals use the term code status to describe the type of treatment you should receive If your heart stops beating or your lungs fail. A code status determination such as a do-not-resuscitate order communicates your wishes to the medical facility. For instance, in the case of full cardiac arrest, code status determines whether you should receive CPR to attempt to restore a heartbeat. If your lungs fail, code status determines whether you should be connected to a breathing machine while doctors attempt to treat the underlying condition that caused your breathing to stop. You may also issue instructions concerning feeding tubes, pacemakers and other invasive procedures at the same time. However, a DNR or other code status instruction supplements rather than replaces advance directives.

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What Circumstances Can Overrule a Living Will?

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Do Catholic Hospitals Honor Living Wills?

You can control your future healthcare even when you are in a coma or incompetent by creating advance directives while you are competent. A living will is a type of advance directive in which you write down your choices for end-of-life care. Generally, medical facilities must honor your directive, although "reason-of-conscience" exceptions can apply.

What Is a Typical Living Will?

Before you are unable to make health care decisions for yourself or cannot provide directions to your doctors, you can create a living will to document your wishes. Then, if your condition won’t allow you to talk to your doctors or understand your medical situation — perhaps because you are in a persistent vegetative state or irreversible coma — your health care providers can consult your living will to direct your care.

How to Write a Florida Living Will

When you are no longer capable of making your health care decisions, your physicians can rely on documents you create now to guide your treatment. Chapter 765 of the Florida Statutes addresses these documents, called advance directives. Sections 765.303 and 765.304 give a suggested form for your living will and instructions on how to enact it.

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