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Your Advance Health Care Directive: What to Include, Who to Consult, and How to Create

Your Advance Health Care Directive: What to Include, Who to Consult, and How to Create

Advanced Health Care Directives (AHCDs) are crucial legal documents expressing your medical preferences in end-of-life scenarios, when you cannot decide for yourself. These documents play a pivotal role in medical decision-making, ensuring that your healthcare aligns with your wishes even when you cannot communicate.


Basic Understanding of AHCDs

Advanced Health Care Directives are legal documents that outline your healthcare preferences in end-of-life scenarios, such as if you are suffering from a terminal condition and there is no reasonable expectation of your recovery.  Often, an AHCD is combined with a Health Care Power of Attorney document, and your Attorney-in-fact under your Health Care Power of Attorney document is usually in charge of interpreting and enforcing your AHCD.


Documents Related to AHCDs

There are several other documents related to an AHCD, that can supplement or be an alternative to an AHCD:

  • Living Will: This document is usually an alternative to an AHCD; you would usually choose one or the other, but not both.  
    • An AHCD allows you to specify the kind of medical care you wish to receive or avoid in certain circumstances, particularly when facing a life-threatening illness or injury, usually by saying “Yes” or “No” to various forms of treatments, and specifying when these answers would apply.  
    • However, a Living Will is usually far more limited, and usually states that if you are in an end-of-life scenario, you simply don’t want any treatments that will prolong your life, if you have no reasonable expectations of recovery.  There are not typically choices, or questions to answer “Yes” or “No” to in a Living Will.  
  • Medical Power of Attorney (also known as a Health Care Power of Attorney): This document allows you to appoint someone you trust (an agent) to make healthcare decisions on your behalf should you be unable to do so.  This document usually springs into action only upon your incapacity, but could also be effective immediately upon signing, if you prefer. This person would consult with your healthcare providers to make decisions aligned with your preferences as much as possible.  The main point of this document is establishing the “WHO” – who will make your health care decisions for you if you cannot.  Alternatively, the main point of an AHCD is describing the “WHAT” – what kind of treatments you would or would not want in end-of-life scenarios where there is no reasonable expectation of your recovery.  

The true power of the AHCD lies in their ability to clarify your medical preferences and increase the chances that your wishes are respected and carried out, even when circumstances prevent you from personally making such decisions. AHCDs give you a certain amount of control over your healthcare and foster open communication with your providers, loved ones, and designated agents, helping everyone understand and respect your healthcare wishes. Thus, AHCDs are essential in safeguarding your rights as a patient and preserving your autonomy in healthcare decision-making.


Constructing a Comprehensive AHCD

What to Include in Your AHCD

When creating your AHCD, clarifying your preferences and wishes is a central concern that involves careful consideration. Here are some key concerns that should be addressed:

  • Personal Values: What is most important to you regarding your health, quality of life, and medical treatment? It might involve your views on independence, comfort, lifestyle, religious beliefs, or many other concerns.
  • Desired Medical Treatments: This refers to specific medical procedures or interventions you would want or wouldn’t want under various medical circumstances. It can range from your preferences for resuscitation, intensive care, mechanical ventilation, artificial feeding, and hydration to pain management and palliative care.
  • Personal Health Decisions: These are concrete decisions about your health care, including potential end-of-life care, organ and tissue donation, burial arrangements, etc.

To address these elements effectively, it’s essential to understand each aspect thoroughly, and to consider the many different outcomes that could occur. Engage in reading and research, talk to your attorney about these issues, have detailed discussions with your doctor, and talk with your family members or loved ones as needed.

Who to Consult When Creating Your AHCD

Creating an AHCD should be a collaborative effort involving consultations with several key individuals, such as:

  • Your Attorney; 
  • Your Physician(s): Your doctors can provide medical advice, explain treatment options and potential outcomes, and help you make informed decisions;
  • Family Members: They can provide emotional support, help you reflect on your values and preferences, and play a role in communicating your decisions to your healthcare team when necessary or
  • Your Attorney-in-fact or Health Care Agent.   This person will enforce your AHCD, and make decisions on your behalf when you can’t. It’s crucial for them to fully understand your wishes, making them pivotal in creating your AHCD.

Each individual above plays a unique role in the creation of your AHCD, ensuring your decisions are respected and carried out accurately.

Detailed Guide on Creating an AHCD

Creating an AHCD involves several important steps:

  1. Reflect on Your Purpose, Values, and Preferences.   What are you trying to accomplish by creating an AHCD?  Is this the purpose of the AHCD, or more properly served with a different document?  Are you prepared to make decisions about your health care decisions in end-of-life scenarios?: Consider your values, beliefs, and preferences regarding your healthcare decisions.
  2. Consult with Your Own Personal Committee, as Needed: If you are not sure about certain scenarios or decisions, discuss your preferences with those people in your life who are important to you, or whose input you value: perhaps your spouse, children, parents, siblings, loved ones, attorney, doctor(s), agent(s), or those who you are thinking about making your agent(s).
  3. Document Your Preferences: Fill out your AHCD appropriately. If you have an attorney, he or she can answer your questions or advise you on how to make sure the document accurately reflects your wishes to the best extent possible.   
  4. Ensure Legality: There are several aspects of the document that must be done in the correct manner for your document to be legally binding and properly accomplish your goals.  Your attorney can advise you on these items.  Among several other items, your AHCD must be witnessed by two disinterested witnesses.  
  5. Execute the Document: Once completed, sign and have it witnessed per Missouri Law.
  6. Distribute Copies: Give copies of your AHCD to your doctor, healthcare decision maker, attorney-in-fact, or other important family members.

When followed, these steps will help ensure that your AHCD is comprehensive, accurately reflects your wishes, and is legally sound.


Importance of Regularly Reviewing Your AHCD

Reviewing your Advanced Health Care Directive (AHCD) regularly is a good practice. Your health conditions, personal beliefs, and living circumstances may change as time passes, affecting your healthcare preferences. Therefore, ensuring your AHCD reflects your current wishes accurately is very important.

Here are some suggestions related to reviewing and updating your AHCD:

  • Periodic Reviews: As a rule of thumb, review your AHCD at least once every five years, even if nothing significant has changed.  If you have had significant life changes, you should also review your documents.
  • Following a Divorce or Death of a Loved One: Personal losses or changes in your family situation may affect your care decisions.
  • Diagnosis of a Serious Health Condition: An AHCD should be reviewed following a severe illness diagnosis, as your preferences for treatment may change.
  • Decline or Improvement in Health: Significant changes in your health demand a review of your AHCD to ensure it aligns with your current health status and wishes.

Remember, an AHCD is a living document that should grow and change with you, ensuring that your medical care always aligns with your current preferences and values. An AHCD that is regularly reviewed and updated is the best tool to ensure that your wishes are honored, no matter what the future holds.


Securing Your Medical Future

An Advanced Health Care Directive (AHCD) is more than a legal document—it’s a powerful statement of your autonomy and a testament to your foresight in planning your medical care. It ensures that your voice remains heard even when you can’t express your preferences and that your medical treatment adheres to your wishes.

Creating a comprehensive AHCD involves carefully considering your values, desired medical treatments, and health decisions. It’s an iterative process that benefits from open conversations with your loved ones, healthcare professionals, attorneys, and agents. 

An AHCD serves as a guide for healthcare decisions, but as your life changes, so might your views on healthcare and end-of-life decisions. Regularly reviewing and updating your AHCD ensures it accurately reflects your current preferences.  

An AHCD is your healthcare compass, directing caregivers toward the treatment path that resonates with your values, and can ensure your peace of mind daily.  If you have any questions regarding creating or redoing your AHCD, please feel free to contact the offices of The Piatchek Law Firm, LLC, at your convenience.


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