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.
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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.
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.
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.
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.