Charting Your Course : Seminar III - Getting the Signals Straight : Decision Making and Planning

Whether you have cancer or not, you can't predict the future. Each of us should think about how our medical decisions should be made and who should make them if we become too ill to do so ourselves. While you may never become incapable of making your own health care decisions, you can have reasonable assurance and peace of mind by providing for the possibility.

Your doctor or hospital can give you information on preparing a document, or "advance health directive", that is legally sufficient in your state. Common forms of this document are the durable power of attorney (also known as the healthcare proxy) and the "living will".

Appointing someone to carry through your intentions with regard to medical treatment is very serious; it requires thought and discussion. It's better to complete your healthcare proxy in advance, not just when you are planning to enter the hospital.

Completing a healthcare proxy or a living will is voluntary. No one can require you to do so.

A durable power of attorney is a legal document that allows you to appoint someone you trust to decide about your medical treatment if you lose the ability to decide for yourself. It allows you to transfer your legal right to make a health decision to someone you choose as your "agent" or "proxy". Durable means that your agent can make decisions only when you become unable to do so for yourself. Your agent need not be an attorney; most people choose a close family member or friend.

You can give the person you select as little or as much authority as you want. You can allow your agent to decide about all of your health care, or only about certain treatments. You may also give your agent instructions that he or she has to follow.

A living will is a document that provides specific instructions about healthcare treatment. It is generally used to state your wishes about life-sustaining treatment under certain conditions. A living will requires that you know in advance all of the decisions that may arise. In contrast, healthcare proxy allows you to choose someone you trust to make treatment decisions on your behalf. If you complete both a living will and a healthcare proxy form, the living will provides instructions for your healthcare agent and will guide his or her decisions. A living will is not as effective as a durable power of attorney because a living will simply expresses your preferences to your doctor. A durable power of attorney gives legal authority to a person to act in your place and be your advocate.

Many people use advance directives to avoid being kept alive against their wishes when death is near, however it is a mistake to assume that an advance directive means, "Don't treat." Advance directives can also say that the individual wants all possible treatments within the range of generally accepted medical standards.

By making your wishes and values known as specifically as possible in your advance directive, you will know that you will be treated in the way you would wish. Some issues to consider are pain control, comfort care, artificial feeding, mechanical ventilation, and resuscitation. There is no right or wrong answer to these issues. It's up to you to make your own decisions in advance so that if the need arises, your decisions will be followed.

It's easy to cancel or change your advance health directive. Just fill out a new form. In addition, you can require that your directive expire on a given date.

Your advance directive can be followed only if people know it exists. Give a copy to your agent (the person you have chosen to represent you), your doctors, and any other family members or friends you want. You may also give a copy to your lawyer. Keep a copy with your important papers, where others can find it if necessary.

For more information or to obtain an advance directive form:

Call your local hospital's social services, patient education or chaplaincy department.
Call Choice in Dying, Inc. at (800)-989-9455.
Legal forms for all states can be downloaded directly from the Internet [ www.partnershipforcaring.org ]

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This content is derived from the "Charting Your Course Seminars: A Whole Person Approach To Living With Cancer", provided by Norris Cotton Cancer Center.