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Advance Directives (cont.)

Inability to Make Medical Decisions

Advance medical directive becomes effective only when a patient is no longer able to make their own decisions due to mental incapacity. This could be temporary or permanent. If temporary, the patient resumes decision making responsibilities once the temporary condition resolves.

Common situations in which a person may be temporarily or permanently unable or incapable of making complex judgment or end of life decisions are

  • coma (from any cause);
  • stroke (if it results in coma or cognitive deterioration);
  • moderate or severe dementia (Alzheimer's or other types);
  • persistent vegetative state;
  • severe illness requiring placement on breathing machine and inability to communicate;
  • severe medical conditions such as advanced liver failure or kidney failure;
  • traumatic brain injury resulting in the inability to make complex decisions.

Reasons for an Advance Directive

An advance directive is purely optional. All health care facilities such as hospitals that accept federal funding are required by law to ask if you have one and offer you the appropriate information and documents to sign one, if you so choose.

  • You should consider an advance directive if any of the following are true:
    • You want to be sure your voice is heard when you can no longer communicate.
    • You want to be sure that your wishes are respected and followed in the event that you are unable to make medical decisions for yourself.
    • You want to be sure that your wishes about the use of life-support machines or other life-prolonging treatment are followed if you suffer from a terminal condition.
    • You want to be sure that, if you fall victim to a cardiac arrest after you have suffered with a long-term, end-stage medical condition, cardiopulmonary resuscitation (CPR) or other heroic measures will be performed or not performed according to your values and preferences.
  • No doctor or health care professional can force you to complete an advance directive.
  • If you do not complete an advance directive, then you will receive medical care to the fullest extent appropriate for your condition. In these situations, your next of kin automatically becomes your surrogate decision maker.
  • It is often easier for family members and next of kin to make end-of-life decisions for a patient when the patient's wishes have been clearly delineated. The emotional pressure, feeling of guilt and grief about making the wrong choice, and uncertainty about the patient's own preferences can be overwhelming for the loved ones. Even if a legally executed living will is not done, it is important for family members and loved ones to specify their wishes in case of terminal medical conditions.
  • If you cannot speak for yourself and you do not have an advance directive, then health care professionals will look to the following people, in the order listed, for guidance with your care:
    • Your guardian (if court appointed)
    • Your spouse
    • Your adult child (or the majority of adult children who are reasonably available)
    • Either of your parents
    • Your adult brother or sister (or the majority who are reasonably available)
    • Other adult relatives
    • A close friend who is familiar with your activities, health, or religious or moral beliefs
    • Caregivers
    • A court-appointed or state-assigned conservator in cases where no relative or friend exists to guide medical decision making (conservators may be previously assigned to a patient, otherwise this could be a very lengthy legal process)
    • Primary care physicians or attending physicians are in rare cases asked to comment or decide on a patient's behalf and in patient's best interest if all efforts have been exhausted to find a surrogate decision maker.
Medically Reviewed by a Doctor on 11/20/2017

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