How health directives communicate treatment wishes

Describe the treatment choices that matter to you

MedlinePlus lists dialysis, breathing machines, resuscitation and tube feeding as possible instruction topics. Use these as discussion prompts rather than recommendations to accept or refuse treatment.

The Texas statutory form suggests considering what treatment burdens or hardships you would accept for a particular amount of benefit if seriously ill.

Distinguish financial authority from medical authority

In Minnesota, for example, general authority under the statutory financial power of attorney does not include health care decisions, and other states differ.

Texas medical agent authority and treatment objections

In Texas, a medical agent may exercise authority only after the attending physician certifies incompetence in writing, based on reasonable medical judgment, and files the certification in the medical record.

Before implementing an agent's advance directive, the attending physician must make reasonable efforts to inform the principal of proposed treatment or proposed withholding or withdrawal.

Under these Texas medical power of attorney provisions, treatment cannot be given or withheld over the principal's objection, regardless of competence or whether the power of attorney is effective.

Texas notification and the medical record

In Texas, the declarant must notify the attending physician of a written directive, and the physician must make it part of the medical record.

Another person may notify the physician if the declarant is incompetent or otherwise mentally or physically incapable of communication.

Florida findings before following a living will

In Florida, proceeding under a living will requires no reasonable medical probability of recovering capacity and a terminal condition, an end stage condition, or a persistent vegetative state.

Any limitations or conditions expressed orally or in writing must also have been carefully considered and satisfied.

The primary physician and at least one consulting physician must separately examine the patient. Each physician's findings must be documented in the medical record and signed before life prolonging procedures may be withheld or withdrawn.

When the principal has expressed wishes in a living will but has not designated a surrogate as described in section 765.304(1), the primary physician may follow those instructions, subject to these requirements.

A disputed withholding or withdrawal decision must await review. If review is not sought within seven days following the physician's decision, the physician may follow the principal's instructions.

Georgia condition certification and revocation

Georgia's official guidance requires written certification of a terminal condition or permanent unconsciousness before withholding or withdrawing life sustaining procedures, nourishment or hydration for a declarant with that condition.

The attending physician and another physician must personally examine the declarant and certify the condition in writing based on their examinations and current accepted medical standards. Certification alone does not establish every prerequisite for withdrawal.

The guidance states that a Georgia advance directive may be revoked regardless of the declarant's mental state or competency. It remains effective after guardian appointment unless a court specifically orders otherwise.

One oral revocation method requires expressing intent before a witness age 18 or older, who confirms it in writing within 30 days. Revocation becomes effective when the treating physician documents it in the medical record.

Share copies and review your instructions

Maryland's optional form advises discussing wishes with family and others close to you, and discussing the agent's role with your selected agent and any backups.

It advises giving completed copies to your agent, doctor and others who might need them. Keep an accessible copy at home and review your instructions periodically.

Periodic review is planning guidance, not an expiration deadline.

Two related terms

Health care agent or proxy: In Minnesota, for example, an appointed individual age 18 or older who makes health care decisions within the directive's authority and applicable activation rules. Other states differ.

Living will: A term for treatment instructions, distinct from appointing a health care agent or issuing a resuscitation order for care outside a hospital.

A caregiver's perspective from Investor Advantage

A presenter described the difficulty of finding something his mother would accept after her care needs changed.

"Unfortunately, that same year, my mother was diagnosed with Alzheimer's dementia and I had to take away her dog for safety reasons. I looked around for substitutes for live animal companions, but she hated everything that I brought home."

Common questions