TheRubins.com

Advance Directives

Living Will and Durable Power of Attorney for Health Care

(1/18/17)- Washington, Vermont. Montana, Oregon, California all have legalized assisted dying laws, and in November, Colorado voters approved a ballot which would allow the procedure by almost a 2/3rds majority. There is a law in the District of Columbia, but its legality is bein g fought over in its court system.

The laws are all based on the Death With Dignity Law Act in Oregon, which was adopted in 1997. That law requires two oral requests and a written one, the approval of 2 physicians and lengthy discussions about the patients desire to end his/her life.

Most of these states have opt-out provisions, under which any institution or individual may decline to fill a prescription drug used for end-of-life purposes. Vitas, the nation’s largest hospice care chain has opted out, as have many Catholic institutions.

(11/25/15)- Medical professionals who sit down with their patients to discuss end-of-life decisions will be paid by Medicare  at a rate of$86 for the first half-hour’s conversation in an office. If the conversation takes place in a hospital, the half-hour session will result in Medicare paying $80.

For an additional 30 minutes, that rate would be $75.If the discussion needs to be re-opened months or even years later, Medicare will pay that same rate for that subsequent session.

(11/6/15)- The Centers for Medicare and Medicaid Services (CMS) announced a ruling that starting January 1, 2016, it would reimburse health-care providers if they have conversations with Medicare patients about end-of-life planning. That decision could affect about 50 million beneficiaries, and also the whole insurance and health-care industry.

Some private insurers have already begun payng medical-providers for this type of discussion as have a handful of state Medicaid programs

(4/5/15)- A fund raiser for the Terri Schiavo Life and Hope Network was held recently in Philadelphia, hosted by the family of Teri Schavo, the 26 year old young female who suffered a heart attack in 1990 that left her in what court appointed doctors called a “persistent vegetative state”. Her husband wanted her removed from her life support system, even though she had no living will or health proxy. Her parents wanted to maintain the life support system.

Our item dated 5/14/05 went into more depth in connection with this matter. Jeb Bush, who was then governor of Florida at that time, was in the forefront of the battle to support Mrs. Schiavo’s parent’s position on this matter.

Mrs. Schiavo’s husband Michael won the right to remove her feeding tube in 2003. At that time, Mr. Bush fast tracked a state law overriding the court order that allowed her feeding tube to be removed. The tube was reinserted.

The Florida Supreme Court ruled that the law was unconstitutional, but a federal law was passed calling for intervention by the federal government in the matter. Ultimately the U.S. Supreme Court declined to hear the case, and Mrs. Schiavo passed away shortly after her feeding tube was removed.

(10/8/14)- The US health system needs major reform to ensure high-quality, affordable, and sustainable end-of-life care for Americans, according to a new Institute of Medicine (IOM) report called Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life.

The 507-page document was released on September 17, 2014, and reports recommendations developed during the past two years by a 21-member national committee. The committee included representatives from various fields involved in end-of-life care: doctors, nurses, religious leaders, geriatric specialists, insurers, and lawyers.

The study was supported by an anonymous donor whose identity remained unknown to the committee.

"This is one of the most comprehensive and up-to-date studies that have been performed on end-of-life care for people of all ages who are approaching death," Victor Dzau, president of the Institute of Medicine, said in a press release. "The time is now for our nation to develop a modernized end-of-life care system as envisioned by this report.”

Tzau added that end-of-life care has changed "remarkably" since the IOM's previous report on this issue in 1997, with palliative care now "well-established" in medicine, nursing, and social work, but there is more than ample room for improvement.

Americans hold "strong" views about the type of care they would like to receive at the end of life. They generally prefer to die at home and with the ability to maintain control over healthcare decisions, according to the report. But there is little, or no, planning put in place. Surveys have suggested that more than 25% of adults, including those aged 75 years and older, have given "no thought" to end-of-life care. "Even fewer" have written down their preferences or talked about them with family or providers, according to the report.

In a system aimed at curative rather than supportive and comfort care, such discussions are crucial to honoring the preferences of dying patients and their families.

What updates do clinicians disagree with in DSM-5?

View Report
Challenges to delivering quality end-of-life care include the growing population of aging Americans, increased cultural diversity in the United States, barriers to accessing care among disadvantaged populations, mismatch between services that patients and families need and what they can actually obtain, growing demand that outpaces the availability of palliative care services, and a wasteful and costly healthcare system characterized by time pressures that interfere with communication and care coordination.

Quality end-of-life care needs to be consistent with patients' values, goals, and preferences, the report maintains. To that end, the authors propose a model for advanced-care planning that would require overhauling and restructuring Medicare, Medicaid, and other health plans.

The report offers recommendations for improving end-of-life care in five key fields.

First, delivery of person-centered, family-oriented end-of-life care should be a priority, the report urges. The committee has proposed 12 core components of quality end-of-life care, including frequent evaluation of the patient's physical, emotional, social, and spiritual well-being; management of pain and emotional distress; referral to hospice or palliative care according to patient needs and desires; and frequent updates to the care plan and access to services, in response to the changing needs of the patient and family.

"Government health insurers and care delivery programs as well as private health insurers should cover the provision of comprehensive care for individuals with advanced serious illness who are nearing the end of life," the authors recommended.

Medicare is currently considering reimbursements for such conversations, and some private insurance companies already do so.

The second recommendation addresses provider-patient communication and advance-care planning. Overall, communication quality about end-of-life care between providers and patients is "poor," the reports says, which often results in more intensive and costly treatment.

Because most people involved in "effective" advance-care planning choose quality of life as opposed to living longer, the authors suggest that advance care planning can reduce health costs by avoiding unnecessary and undesirable interventions. Many people, however, have not spoken with their healthcare providers about their wishes, and most do not have advance directives, the authors point out.

"Professional societies and other organizations that establish quality standards should develop standards for clinician-patient communication and advance care planning that are measurable, actionable, and evidence based,” they advise.

These standards should be mutable, in order to respond to changing needs of the population and to reflect new developments in technology and research. Payers and healthcare delivery organizations need to adopt, support, and integrate these standards into care plans and quality care assessments, the report states.

The third recommendation focuses on professional education and development regarding palliative care. Palliative care education has improved "substantially" during the last decade, the authors note, although "serious problems remain." Although hospice and palliative medicine is now a distinct medical specialty and the evidence base for palliative care has expanded, education of clinicians engaged in providing daily care to dying patients needs improvement. Palliative care remains absent from many medical and nursing schools' curricula, and the number of hospice and palliative care specialists still remains small.

"Educational institutions, credentialing bodies, accrediting boards, state regulatory agencies, and health care delivery organizations should establish the appropriate training, certification, and/or licensure requirements to strengthen the palliative care knowledge and skills of all clinicians who care for individuals with advanced serious illness who are nearing the end of life,” the authors assert.

The fourth recommendation pertains to healthcare policies and payment systems. Although improving the quality of end-of-life care remains an end in and of itself, it could also reduce wasted healthcare dollars by preventing costly acute care and emergency services. Many patients and families often do not want such care, the authors note, and it often provides little benefit. How healthcare dollars are spent needs major reform, according to the committee, with resources directed toward palliative care services such as caregiver training, nutrition services, and home safety.

"Federal, state, and private insurance and health care delivery programs should integrate the financing of medical and social services to support the provision of quality care consistent with the values, goals, and informed preferences of people with advanced serious illness nearing the end of life," the authors recommend.

They call for legislation, public reporting of quality measures, and financial incentives aimed at improving quality care, care coordination, and shared decision making. Health information technology, they point out, should be used to achieve these goals.

The fifth and final recommendation calls for increased public education and engagement. Although aging baby boomers may generate increased public interest in this issue, engagement needs to occur at the societal, community, family, and individual levels, the report says.

Important considerations include sponsorship by key stakeholders, identification of target audiences, as well as development and selection of appropriate messages and media.


"Civic leaders, public health and other governmental agencies, community-based organizations, faith-based organizations, consumer groups, health care delivery organizations, payers, employers, and professional societies should engage their constituents and provide fact-based information about care of people with advanced serious illness to encourage advance care planning and informed choice based on the needs and values of individuals," the committee recommends.

"A palliative approach can offer patients near the end of life and their families the best chance of maintaining the highest possible quality of life for the longest possible time," the report concluded. "The committee believes a patient-centered, family-oriented approach to care near the end of life should be a high national priority and that compassionate, affordable, and effective care for these patients is an achievable goal."

The report was funded by an anonymous donor.

Institute of Medicine. Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life. Washington, DC: The National Academies Press, 2014.

(3/31/11)- Many legal experts assert that living wills are too vague, and that more explicit instructions should be available for physicians to follow when it comes to end-of-life determinations. So far 14 states, including California and New York have adopted programs known as Physicians Orders for Life-Sustaining Treatment or Polst to better deal with this situation.

Polst is meant to complement living wills, and it must be signed by both a physician and the patient. It directly states whether or not a patient wants to be put on a breathing machine or feeding tube and receive antibiotics. It becomes part and parcel of an individual's medical records.

Sixteen states are currently working on developing this type of program. The programs train health-care providers to discuss end-of-life treatment choices with patients with terminal illness or anyone wishing to define their care preferences.

(3/24/11)- In response to a petition filed by the Alliance Defense Fund, a Christian legal alliance on behalf of the children of Rachel Nyirahabiyambere, as we discussed in our item dated 3/6/11 below, Judge Nolan B. Dawkins of the Alexandria Circuit Court ordered that her feeding tube be reinserted immediately.

The court will continue to oversee the matter as the issues that have arisen in connection with this case works its way through the legal system.

(3/6/11)- Rachel Nyirahabiyambere, a 58-year old legal immigrant from Rwanda had her feeding tube removed by order of her court-appointed guardian on February 19 of this year. She had been in a persistent vegetative state since suffering a major stroke in April.

Her six adult children, two of whom are U.S. citizens, vehemently opposed the removal of a feeding tube that had been keeping her alive. She had been a patient at the Georgetown University Medical Center for over 8 months.

Ms. Nyirahabiyambere did not have medical insurance because she had not been eligible for Medicaid coverage since she had not been in this country the requisite 5 years that would have entitled her to that coverage.

After she had been in the hospital for 7 weeks the hospital sought to have Ms. Nyirahabiyambere discharged to a nursing home

Since her children opposed the removal of the feeding tube, Georgetown petitioned a court in Alexandria, Va. in November seeking to have a guardian appointed so that the costly procedure could come to a head. Judge Nolan B. Dawkins of the Alexandria Circuit Court appointed Andrea J.Sloan, who is a lawyer and nurse as her guardian.

Ms. Sloan arranged to transfer Ms. Nyirahabiyambere to a Maryland nursing home, and Georgetown agreed to cover the home's costs. The stay in the nursing home was short lived, whereupon she was transferred to hospice care.

It has now been over three weeks since the feeding tube has been removed and Ms. Nyirahabiyambere is still alive today.

(8/18/10)- The appellate division of the Superior Court of New Jersey dismissed Trinitas Regional Medical Center's appeal of the lower court ruling that the hospital had erred when it withdrew the life-support system from a dying man against his daughter's wishes. For more info on this matter please see our item dated 6/7/10 below

The court ruled that the matter was moot since the man had died. The judges also said that there was an insufficient understanding of the patient's neurological condition for them to rule on the merits of the case.

The case involved Reuben Betancourt, a patient who lapsed into a coma after surgery in 2008. The hospital placed a "Do Not Resuscitate" order on his chart even though his daughter did not approve of this action by the hospital.

The family filed a suit and in March 2009, a Superior Court judge ordered that treatment of the patient Betancourt was to be resumed. Mr. Betancourt died two months later at the age of 73.

Trinitas appealed that ruling on the grounds that continuing dialysis and life support on a near-brain dead man was unwarranted and unethical. Mr. Betancourt's daughter Jacqueline argued that her father was aware of the family's presence and that he had been responding well to kidney dialysis treatment

Todd Drayton, Ms. Betancourt's attorney, argued that the case was moot, since Mr. Betancourt had passed away, so that any court's ruling would have no effect on Mr.Betancour's treatment.

(6/7/10)- Suppose a patient does not have a living will, and the hospital determines that end-of-life care is no longer warranted, but the family of the patient wants care to be continued. Who prevails in this matter, the hospital or the patient's family?

The appellate division of the Superior Court of New Jersey should be handing down a decision in this type of case very shortly.

The patient involved in the case, Ruben Betancourt of Elizabeth, N.J., had been unable to speak for more than a year, and he died in May 2009, a year before the appellate judges heard arguments in the case.

His daughter, Jacqueline Betancourt instigated the legal action against the Trinitas Regional Medical Center in Elizabeth, because she wanted to keep her father on life support system. Mr. Betancourt did not have a living will nor had he appointed anyone to make medical decisions for him in the event he could not make them for himself.

Ms. Betancourt argued that her father had been responsive as shown by some of his movements, while the hospital argued that he was in a persistent vegetative state.

The hospital had appealed a lower court ruling from 2009 that ordered Trinitas to continue to provide life-supporting treatment to the patient.

Back in the 1970's the parents of Karen Ann Quinlan brought suit against St. Claire's Hospital of Denville, N.J. asking for the right to remove a breathing machine from their comatose daughter. The New Jersey Supreme Court sided with the parents in this case and the ventilator was removed and Karen Ann was moved to a hospice. She lingered several months before passing away.

(8/13/07)- An interesting case is wending its way through the court system that involves the right of a terminally ill patient to receive medications that have not been approved by the FDA. In the most recent federal decision on this matter, the Court of Appeals for the District of Columbia Circuit, in an 8-2 decision ruled that such patients do not have a constitutional right to this type of medication.

The Abigail Alliance for Better Access to Developmental Drugs filed the case against the FDA in 2003. The group was founded by Frank Burroughs whose daughter Abigail died from cancer after a long battle to receive treatment with experimental drugs that were eventually approved.

The Abigail Alliance was joined by the Washington Legal Foundation as plaintiff. The plaintiffs argued that forcing patients to wait years for a drug to go through the process of clinical trials deprived dying patients of their right to self-defense and violated the Fifth Amendment which states that people cannot be deprived of life, liberty or property without due process.

A district court ruled against the Abigail Alliance, but an appeals court panel reversed the decision. The full appeals court however upheld the district court decision. Judge Thomas B. Griffith, writing for the majority, said a right to experimental drugs was not deeply rooted in the nation's history and tradition.

Mr. Burroughs vowed to appeal the decision to the Supreme Court.

(3/13/06)- A number of readers have asked us to summarize information appearing in the articles on Advanced Directives. While we believe reading the full articles are important, we present this summary below.

Advanced directives can be executed without an attorney. There are four basic types of advanced directives. In planning ahead, one should be aware of the most common treatment procedures that are taken into account when doing an advanced directive. The six most common are

1.artificial feeding
2.endotracheal tube to support artificial respiration
3.hemodialysis treatment
4.antibiotic administration
5.comfort measures including administration of pain medication
6.blood transfusion

The four basic advance directives are

1. Health Care Proxy
2. Written statement of desires
3.
Living will

4. Do not resuscitate (DNR) order.

In New York State the health care proxy is recognized as a legal document. Upon admittance to a hospital in NY State, the hospital is required to provide the patient with a health care proxy. It is better to prepare a health care proxy before entering a hospital.

A written statement would have to cover all the specific situations/health care decisions that might arise. Since there are many different treatments and situations that may arise, this form of advanced directive may have limited value.

A Living will has not been adopted as statutory law in New York State.

DNR order can be obtained from a family member or a close friend, if you have not already so directed this step.

In general, it seems most advantageous to have a health care proxy and make sure this information is in the chart. Secondly, inform your treating physician before hand if you have any special instructions regarding your health care treatment. This should also be recorded in your chart.

(2/4/06)- It has been almost one year since Terri Schiavo passed away in March 2005, but her case still reverberates throughout society today. To update our viewers, there was a recent news item that her husband Michael Schiavo married his girlfriend, who he met after Teri was already in a nursing home about 11 years ago. Terri died after her feeding tube was removed in spite of the objections to the removal by her parents.

The autopsy that was performed supported Michael Schiavo's contention that Terri Schiavo was in a persistent vegetative state with no consciousness and no hope of recovery. As a reminder to all our viewers, you will find linkages in this article to sites where you can download living wills and durable power of attorney forms at no cost to you at all.

(1/23/06)- Although some of the facts are in doubt, an interesting matter arose in Texas in connection with the discontinuance of life support system for a 27-year-old legal immigrant at the Baylor Regional Medical Center in Plano, Tex. The state has a law that was signed by the then Governor George W. Bush that relieves medical facilities and personnel of any obligation to provide life-sustaining treatment 10 days after having provided formal notice that such treatment was found to be medically "inappropriate".

The patient in question, Tirhas Habtegirls, was a 27-year-old legal immigrant who had no medical insurance. She was being kept alive by a ventilator as she lay dying of cancer. Medical professionals felt that there was no hope of recovery. On December 1, 2005, hospital authorities notified her brother that unless another hospital could be found that was willing to accept his sister, Baylor would be forced to discontinue care after 10 days.

Both sides agree to the fact that Baylor did everything possible to help the family find another medical facility willing to accept Ms Habtegirls. After the 10days had elapsed, and the family was unable to find another medical facility willing to accept the patient, Baylor discontinued the ventilator. Ms. Habtegirls passed away within 16 hours after the ventilator was discontinued.

(12/13/05)- New York State recently had a case involving feeding-tubes and living wills that is quite interesting. The facts of this case are as follows:

Lee Kahan, was an 86-year old New Yorker who suffered from advanced Alzheimer's and could no longer swallow on her own. She had signed a living will in 1988 in which she stated that she would want her life sustained only if there was hope for recovery. Her daughter, Joan Simonson who was 43 years of age was named as her agent.

The daughter, Joan Simonson did not want a feeding tube (PEG) inserted into her mom to help sustain her life. Her sister Rose Borenstein filed a lawsuit saying that as an Orthodox Jew, Mrs Kahan should have the tube inserted to prolong her life. Agudath Israel, and orthodox group, supplied Ms. Borenstein with a lawyer, Samuel Abady, to pursue the matter.

In February of this year New York Supreme Court Judge Martin E. Ritholtz ordered Ms Simonson to keep her mother alive as long as medically possible. The court reached its decision in part because of the fact that Mrs. Kahan's living will was incomplete since she had not checked off a box stipulating whether she wanted a feeding tube.

(5/14/05)- In the wake of the Terri Schiavo case in Florida, many state and some federal legislators have introduced legislation to deal with the matter of medical care for seriously ill patients and patients who are on life support medical devices. Three states, Texas, California and Virginia already had enacted so-called "futile care" laws.

"Futile care" laws are laws in which doctors and hospital ethics committees can overturn the decisions of family members who seek to keep a patient alive when there is no hope based on a pure medical decision. In Texas, if the agent seeks to keep the patient on a life support system, he/she has 10 days to find another medical facility willing to keep the patient on the system. The Texas law was enacted in 1999 when the governor of the state was George W. Bush.

There was another interesting case in Florida involving a situation where the agent wanted the medical facility to keep the patient alive even though his living will had rejected keeping him on a life support system. In that case Alice Pinette of Orlando, Fla. demanded that the hospital keep her 73-year old husband on life support even though he had specifically rejected such measures in his living will.

The medical facility took the matter to court. The judge in this matter ruled in favor of ending the life support system as directed in the patient's living will, rather than siding with the wife who was the health agent.

(4/5/05)- In New York State you do not need to have your signature notarized when you sign the advance directive documents, nor do you need the signature of either of the two witnesses to the documents to be notarized. Your health care agent should not be a witness to any of your health directives if at all possible.

Under New York Health Care Proxy law, your agent's authority to make health care decisions begins only when two doctors determine that you have lost capacity to make decisions for yourself. If your spouse is your appointed health care agent, your Health Care Proxy is automatically cancelled upon divorce.

(4/4/05 updating material on 3/24/05)- For those of you who are interested in obtaining advance directive forms in the State of New York, they can be found on the state's attorney-general's site at www.oag.state.ny.us . Once you are on the site link into the section entitled "Protecting and Strengthening the Family". The menu contains a section entitle "Health Care" from which you can download the Health Proxy Form. You can get the health proxy download information from the New York State Health Department site also.

There is no charge for downloading the form. Please make sure that any advance directive form that you fill out conforms to the law of the state where the form is executed. New York State requires two witnesses to sign a Health Proxy. You can name a contingent agent in case the primary agent if the first person you appointed is "unable, unwilling or unavailable to act" as your health care agent.

You should give the signed and witnessed copy of any advanced directive that you filled out to your physician to be included in your medical records. Please also see the email at the end of this article which tells you how you can get the directive filed electronically so that it is available to be viewed by any hospital that may need to get the information contained therein.

It is optional for you to designate a contingent agent in the advance directive just in case the primary agent is unavailable. You do not need to have an attorney draw up the form. You can change your selection of Health Care Agent as frequently as you like, but make sure each change is properly witnessed, and conforms to the state where you are in when you execute the document. The law of the state where you execute the document is the controlling law in the matter. You can not designate a minor under the age of 18 as your agent in the state of New York.

We also note that unless you are a member in a Health Care Provider or Community Provider in your area, there is a $25 lifetime fee to have your health directive registered with the Living Will Registry. It is not free under this circumstance as we previously had erroneously had written

(3/31/05)-There are two other articles that have appeared on this site that might be of interest to those of you who want to look at ancillary issues to Advance Directives. Although these are not recent, they still have a bearing on this topic. They are:

Terminal Sedation

Medical Ethics and Research with the Elderly

Harold Rubin wrote both of these articles.

(3/30/05)-We need our viewers input into a question in connection with advanced directives that we at therubins do not know the answer for. The question is specifically-"What criteria do the medical authorities utilize in determining whether or not an individual has the mental capacity to be able to comprehend the medical alternatives involved in their own treatment?" We could phrase that same question as to "When does the medical power of attorney come into play in determining who should make the decision as to how a patient should be treated by their medical professionals."

Our mom, in whose memory we started this site, was a resident of a nursing home for 4 1/2 years. For our article on this topic please see: Selecting a Nursing Home-A Personal Story. Many of the residents were elderly people who were certainly competent and alert. As far as being able to understand the different options that were available to treat their physical illnesses-that was much more of an "iffy" situation.

We do not know how the home deals with these "iffy" situations. If any of our viewers know how medical professionals determine when to bring the power of attorney into use, we would appreciate their emailing us that info. We would like to be able to include that email in this article, but if you prefer to remain anonymous we will respect your wishes.

If you are not a member in a registered Health Care Provider or Community Provider there is a $25 lifetime fee for having your health directives filed with the Living Health Registry. It is not free as we previously erroneously had written in this article.

(3/26/05)-Beginning April 1, the National Hospice & Palliative Care Organization will have all state forms available on it site for advanced directives. The site's address is www.caringinfo.org . An advance directive typically includes both a health-care proxy and a living will. The living will states the type of treatment that you will or won't receive when you are ill. The health care proxy designates an individual who you want to have make the medical decisions for you in the event that you can not make those decisions for yourself.

In a 2003 survey conducted by AARP, only two in five adults age 45 or older had a health-proxy and living will.

One of the most difficult decisions that a hospital has to make when a person is seriously ill, is if that person has the mental capacity to be able to understand the meaning of making a decision. Many hospitals have their ethics committee make the decision in regards to mental capacity in ambiguous cases.

(3/24/05)- For those of you who are interested in obtaining advance directive forms in the State of New York, they can be found on the state's attorney-general's site at www.oag.state.ny.us Once you are on the site link into the section on Health Care to find the form that is appropriate for your needs. You can download the forms that you need for free. Please make sure that any advance directive form that you fill out conforms to the law of the state where the form is executed.

You should give a notarized signed and witnessed copy of any advanced directive that you filled out to your physician to be included in your medical records. Please also see the email at the end of this article which tells you how you can get the directive filed electronically so that it is available to be viewed by any hospital that may need to get the information contained therein.

It is optional for you to name a contingent agent in the advance directive just in case the primary agent is unavailable.

(10/12/00)-The Health Care Decisions Law went into effect in California on July 1, 2000. This law establishes a standardized form through which patients can inform their treating physician and other caregivers of their preferences regarding withholding and/or withdrawing life sustaining treatment, do-not-resuscitate (DNR) orders, advance directives and appointment of health care proxies.

The law expands on the California Natural Death Act, already in force. This particular legislative act created a standard living will in which the individual can make certain declarations about end-of-life treatments. The new legislation calls for completion of a Durable Power of Attorney for Health Care. In it a person appoints another individual as the health care agent if he/she is unable to communicate his/her wishes to the attending physician. The individual can withdraw the health care proxy at any time. For those interested in obtaining these forms. Contact the California Medical Association publication department at 415-882-5175.

A living will represents a way an individual can plan for the unforeseen events that occur in life. It allows you to state what type of health care you should or should not get when you have a medical emergency. It is imperative that you let the person who you appoint as your agent know what type of medical treatment you want or do not want in the event of a medical emergency. You should clearly state to the agent whether or not you want extraordinary means to be taken in the event of your undergoing an end-of-life medical situation.

In the event that you are unable to speak for yourself in a medical emergency the agent will speak for you. If you do not want to be kept alive through extraordinary means it is imperative that you have a living will filled out and properly signed.

Give a copy of your living will to your doctor, and have the document placed in your medical records. It is also advisable to tell a relative or friend about the existence of such a document and tell them where they can find your living will. In the article below we have included an e-mail we received as to how to have your living will recorded electronically.

The American Bar Association’s Commission on Legal Problems worked with Aging With Dignity, under a grant from the Robert Wood Johnson Foundation to prepare a document that is now legal in at least 33 states. The document cannot be used as a legal will in Alabama, Alaska, California, Indiana, Kansas, Kentucky, New Hampshire, Nevada, Ohio, Oklahoma, Oregon, South Carolina, Texas, Utah, Vermont, West Virginia or Wisconsin.

They have established a web site where you can find several simple Living Will templates to choose from including the National Right to Life Committee’s "Will to Live." The site address is: http://www.agingwithdignity.org Look through the different samples and select the one most appropriate for your needs. We suggest that you do not delay in doing this. It is free and can always be changed as your needs change.

Another non-profit organization called Choice in Dying will provide information about living wills. Their phone number is (800) 989-9455. Their web site address is: www.choices.org

In a Durable Power of Attorney for Health Care, which is frequently called a Health Proxy, you pick another person who will make the medical decisions for you when you are either physically of mentally unable to make the decisions for yourself. The person you select is called the "agent" and can be anyone not a minor who you have the confidence in, to make important medical decisions for you.

If you so desire you may also name a contingent agent in the document, who will be empowered to make the decisions needed if your primary agent is unavailable. Make your wishes known to your agent as to what type of treatment you do or do not want administered to you in the event of a medical emergency.

"Durable" Power means that the subsequent disability or incompetence of the principal does not invalidate the Power. A sentence in the Power must expressly state that it is durable. You should give a copy of your Health Proxy to your doctor and tell your family or close friend where you have placed your Health Proxy. Please remember not to put it in your vault or no one will be able to retrieve it when it is needed the most.

Most states require that you sign both the Living Will and the Health Proxy in the presence of 2 witnesses and that your signature be notarized and dated. Usually, your own state's Attorney General's Office has forms available for you to use for both the Living Will and the Health Proxy. Health facilities serving Medicare or Medicaid beneficiaries are required to advise you as to Advance Directives.

You must be advised of your legal right to refuse any medical care that you do not want. If you do not want to have an Advance Directive you do not have to have one. As long as you have the mental competency to do same you may revoke your Health Directive at any time you chose.

As a service to our viewers we pass on to you a copy of an e-mail that we received on June 20, 1999 which pertains to the topic we have written about herein. We make no representation on the legality of the claims made therein. It is up to you to make your own judgment about this matter. We do feel however that you should spend some time to look at this site, it could be of great benefit to you and your loved ones.

We also note that unless you are a member in a Health Care Provider or Community Provider in your area, there is a $25 lifetime fee to have your health directive registered with the Living Will Registry. It is not free under this circumstance as we previously had erroneously had written

"I recently visited your web site and thought you might be interested in our FREE service.

While having an advance directive is important, it is even more important to have that document available when it is actually needed. U.S. Living
Will Registry stores advance directives electronically and makes them available to hospitals across the country 24 hours a day through a state of
the art, automated telephone-facsimile system. Only hospitals have access to the document.

Our storage and transmission systems are legal and valid in all 50 states. No identification cards are needed. Hospitals simply call our
toll-free number (1-800-LIV-WILL) and can inquire as to whether ANY patient has an advance directive registered by entering the social security
number of the patient (each hospital has its own password to access the system). If an advance directive is registered for that individual, the
document is automatically faxed to that hospital's pre-registered fax number. The document is confidential and secure and becomes a part of the
medical record. Registrants are contacted annually to confirm that the advance directive has not been changed or revoked.

This service is free of charge. For more information, visit our web site at
www.uslivingwillregistry.com. Visitors to your web site may be
interested in this free service. You have our permission to create a link to our web site should you so desire. Should you have any questions,
please call us at 1-800-LIV-WILL or email us at
admin@uslivingwillregistry.com.

Thank you,
Joseph T. Barmakian, MD"

FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "HOW TO SELECT A NURSING HOME".

By Allan Rubin and Harold Rubin
updated January 18, 2017

To e-mail: hrubin12@nyc.rr.com or allanrubin4@gmail.com

Return to Home

TheRubins.com