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.

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

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.

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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 Is the Difference Between a Living Will & a Last Will & Testament?

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Power of Attorney and Wills

You may grant power of attorney to an individual who serves as an agent to handle your legal or financial affairs. You may also appoint someone to serve as an executor to handle the final disposition of your estate after you die. One person may serve both functions; however, there are differences between the two sets of duties.

Is a Living Will Valid After Death?

When you become unable to make your own medical decisions, someone else must make those decisions for you. A living will communicates your wishes to medical providers and trusted friends and family when you can’t. Since a living will does not provide directions for what happens after a patient dies, it is not valid after death.

Guardianship Vs. Durable Power of Attorney

No one likes to consider the possibility of becoming physically or mentally incapacitated. However, guardianship and durable power of attorney provide two possible alternatives to ensure the proper handling of your affairs if you are not able to do so for yourself. The two roles are similar, but there are significant differences between them.

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