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You can decide in advance what medical treatment you want to receive in
the event you become physically or mentally unable to communicate your
Your rights as a patient
All adults in hospitals, skilled nursing facilities, and health care
settings have certain rights. For example, you have a right to
confidentiality of your personal and medical records and to know what
treatment you will receive.
You also have another right. You have the right to prepare a document
called an "advance directive." In one type of advance directive, you
state in advance what kind of treatment you want or do not want if you
ever become mentally or physically unable to choose or communicate your
wishes. In a second type, you authorize another person to make those
decisions for you if you become incapacitated. Federal law requires
hospitals, skilled nursing facilities, hospices, home health agencies
and health maintenance organizations (HMOs) serving persons covered by
either Medicare or Medicaid to give you information about advance
directives and explain your legal choices in making decisions about
The law is intended to increase your control over medical treatment
decisions. Be mindful, however, that state laws governing advance
directives do differ. The health care provider is required to give to
you information about the laws with respect to advance directives for
the state in which the provider is located. If you reside in another
state, you may wish to gather information about your state laws from
another source such as the office of the state attorney general.
What is an advance directive?
Generally, an advance directive is a written document you prepare
stating how you want medical decisions made if you lose the ability to
make decisions for yourself. The two most commonly prepared advance
* a "Living Will"; and
* a "Durable Power of Attorney for Health Care."
The value of an advance directive is that it allows you to state your
choices for health care or to name someone to make those choices for
you, if you become unable to make decisions about your medical
treatment. In short, an advance directive ensures your right to accept
or refuse medical care. You can say "yes" to treatment you want, or "no"
to treatment you don't want.
A living will generally states the kind of medical care you want (or do
not want) if you become unable to make your own decision. It is called a
living will because it takes effect while you are still living. Most
states have their own living will forms, each somewhat different. It may
also be possible to complete and sign a pre-printed living will form
available in your own community, draw up your own form, or simply write
a statement of your preferences for treatment. You may also wish to
speak to an attorney or your physician to be certain you have completed
the living will in a way that your wishes will be understood and
Durable Power of Attorney for Health Care
In many states, a durable power of attorney for health care is a signed,
dated, and witnessed paper naming another person, such as a husband,
wife, daughter, son, or close friend, as your authorized spokesperson to
make medical decisions for you if you should become unable to make them
for yourself. You can also include instructions about any treatment you
want to avoid. Some states have specific laws allowing a health care
power of attorney, and provide printed forms.
Which is better.. A living will or a durable power of attorney for
In some states, laws may make it better to have one or the other. It may
also be possible to have both, or to combine them in a single document
that describes treatment choices in a variety of situations (ask your
doctor about these) and names someone (called your "agent" or "proxy")
to make decisions for you, should you be unable to make decisions for
The law on honoring an advance directive from one state to another is
unclear. However, because an advance directive specifies your wishes
regarding medical care, it may be honored wherever you are, if you make
it known that you have an advance directive. But if you spend a great
deal of time in a state other than your home state, you may wish to
consider having your advance directive meet the laws of both states, as
much as possible.
Advance directives are not required and may be cancelled at any time
You do not have to prepare an advance directive if you do not want one.
If you do prepare one, you have the right to change or cancel it at any
time. Any change or cancellation should be written, signed, and dated in
accordance with state law, and copies should be given to your doctor, or
to others to whom you may have given copies of the original. In
addition, some states allow you to change an advance directive by oral
If you wish to cancel an advance directive while you are in the
hospital, you should notify your doctor, your family, and others who may
need to know. Even without a change in writing, your wishes stated in
person directly to your doctor generally carry more weight than a living
will or durable power of attorney, as long as you can decide for
yourself and can communicate your wishes. But be sure to state your
wishes clearly and be sure that they are understood.
Make sure that someone, such as your lawyer or a family member, knows
that you have an advance directive and knows where it is located. You
might also consider the following:
* If you have a durable power of attorney, give a copy or the
original to your agent or proxy.
* Ask your physician to make your advance directive part of your
permanent medical record.
* Keep a copy of your advance directive in a safe place where it can
be found easily, if it is needed.
* Keep a small card in your purse or wallet stating that you have an
advance directive, where it is located and who your agent or proxy is,
if you have named one.
Who should prepare an advance directive?
You may want to consider preparing an advance directive if:
* you want your physician or other health care provider to know the
kind of medical care you want or don't want if you become incapacitated.
* you want to relieve your family and friends of the responsibility
for making decisions regarding life-prolonging actions.
If you need help in preparing an advance directive, or if you would like
more information, you may want to contact a lawyer, a nearby hospital,
hospice or long-term care facility, or your state attorney general's
Excerpted from material by U.S. Dept of Health and Human Services 1993
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