Advance Medical Directives for Aging Loved Ones

Can you tell me how to make sure that my elderly father's medical wishes will be respected? He's in ill health, and he has often said that he doesn't want any heroic measures taken to prolong his life. I know that we need to establish formal documentation of his desires in this regard, but I have no idea how to go about it.

We strongly suggest that you engage a lawyer to help you and your dad draw up an advance medical directive, a legal document that provides guidance for medical professionals and loved ones when a patient cannot speak for himself. If at any point it becomes necessary for your father to enter a hospital, the staff will ask about an advance directive. There are primarily two different kinds of directives that your father can set up now, while he’s still mentally competent, as a way of providing for medical decisions and disability planning.

The living will is a signed and witnessed document that provides a list of things the doctor can and cannot do if your father is in a terminal condition. Generally speaking, it’s a declaration of end-of-life preferences that rightly gives authority about medical decisions to a patient while he’s lucid. However, a living will is limited in use and can be of benefit only when a person is terminal (which usually means having six months or less to live). Some find it troubling because the word terminal and the phrase “unable to make medical decisions” are vague and can be broadly interpreted. Furthermore, another valid concern is that in your absence, the attending physician on duty could make a decision you, your dad, or your primary doctor would not agree with. For these and other reasons, we do not recommend a living will.

What we do recommend is a Durable Power of Attorney for Health-Care Decisions (DPAHCD) – a document that designates an agent who will make health-care decisions when the patient is unable to do so. The DPAHCD appoints an agent in any crisis, not just terminal illness. If he chooses this arrangement, your father should use great care in selecting an agent, because that individual will have authority to make decisions about providing, withholding or withdrawing medical treatment when he is unable to make these decisions himself. This document confers significant authority, and many people will include a letter of instruction to their DPAHCD agent providing them with guidelines for medical and custodial decision-making. Only a court can take away the powers of the agent if it finds that he or she has abused that authority.

The Patients Rights Counsel, which urges everyone to have some form of advance directive, has devised one of its own, the Protective Medical Decisions Document (PMDD), which may be attached to the advance directive form(s) approved by your state legislature. In effect, it is a protective DPAHCD document that specifically prohibits assisted suicide and euthanasia. The PMDD makes it clear that your loved one’s agent (who could be a spouse, family member or close friend) does not have authority to approve the direct and intentional ending of his life. It forbids the agent from authorizing a lethal injection or drug overdose. It also prohibits him from directing that your father be denied food or fluids for the purpose of causing death by starvation or dehydration. It also states that Do Not Resuscitate (DNR) decisions and other such directives are to be handled only by the agent.

Before an advance directive is signed, it should be discussed with the entire family so that nothing comes as a shock during a crisis. Once signed, a copy should be given to your dad’s primary doctor and taken to the hospital or other health care facility if your father is admitted. Keep copies and review the document annually (perhaps at income-tax time) or any time there is a significant change in your father’s health, relationships, or location. If your father agrees, it might be wise to give a copy of the document to any of his close relatives who would like to receive it – especially the person or persons he’s named to make medical decisions.

One last thought. This is complicated material. That’s why you and your father need all the legal advice you can get. It’s a good idea to find a lawyer or financial planner to assist you through contacts you may have at church, in your family, or through your work – someone who has proved competent and trustworthy and who generally shares your values. And don’t forget to pray. This job is bigger than any one person can handle without divine intervention.

If you could use further information and guidance, please don’t hesitate to give our Gift and Estate Planning staff a call. They would be happy to listen to your concerns and assist you with some practical suggestions. You can contact them Monday through Friday between 8:00 a.m. and 5:00 p.m. Mountain time at (800) 782-8227.


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Caring for Aging Parents

Christian Medical & Dental Associations

National Association of Area Agencies on Aging

Caregiver Action Network

Caring for Elderly Parents: The Complete Guide

Caring for Ill or Aging Parents

Discussing Your Medical Wishes: A Patient’s Guide

Making Medical Decisions for a Loved One: A Caregiver’s Guide

Advance Medical Directives

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