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ADVANCE DIRECTIVES
 

THE LIVING WILL AND DURABLE POWER OF ATTORNEY

FOR HEALTH CARE

 

Explanation of Terms and Procedures 

An advance directive is a document in which an individual makes provision for future medical treatment decisions in the event that he/she loses decisionmaking capacity. 

One type of advance directive is the living will, which indicates what forms of medical treatment an individual wishes to receive or forgo should he/she be terminally ill and lack decisionmaking capacity. 

A durable power of attorney for health care is a proxy directive in which an individual designates someone (called the attorney in fact or agent) to make medical decisions on his/her behalf if he/she should lose decisionmaking capacity. It is a different document than a power of attorney for financial matters. A durable power of attorney for health care may include stipulations about types of treatment that are/are not wanted in specified conditions. 

In the State of Iowa, both the living will and the durable power of attorney for health care have the status of being legal documents. 

 

Policy

 Each person has a right to make his/her own health care decisions.  In the case of someone who does not have the capacity to make health care decisions, a proxy decisionmaker may assume that responsibility. Thus it is permissible to execute advance directives, as long as their stipulations are in conformity with the teachings of the Catholic Church. 

In particular, the Catholic moral tradition recognizes that there are cases in which it is morally permissible to forgo life-sustaining treatments. An advance directive may legitimately be used as a means of legal protection for an individual against the administration of life-sustaining treatments which are not morally obligatory for him/her to use. It is not permissible, however, to use such documents as a means to facilitate euthanasia or assisted suicide. 

Sources of Policy 

In an address to an International Congress of Anesthesiologists on November 24, 1957, Pope Pius XII affirmed the right of an individual to make his/her own health care decisions, and at the same time recognized proxy decisionmakers who represent the patient: 

The rights and duties of the doctor are correlative to those of the patient. The doctor, in fact, has no separate or independent right where the patient is concerned. In general he can take action only if the patient explicitly or implicitly, directly or indirectly, gives him permission. ...The rights and duties of the family depend in general upon the presumed will of the unconscious patient if he is of age and "sui juris" (1) 

     Similarly, the Vatican Declaration on Euthanasia (1980) states: 

In numerous cases, the complexity of the situation can be such as to cause doubts about the way ethical principles should be applied. In the final analysis, it pertains to the conscience either of the sick person, or of those qualified to speak in the sick person's name, or of the doctors, to decide, in the light of moral obligations and of the various aspects of the case. (2) 

The Ethical and Religious Directives for Catholic Health Care Services likewise affirms the prerogative of a patient or his/her proxy decisionmaker to make health care decisions, provided that their wishes are in conformity with the teaching of the Catholic Church: 

The free and informed health care decision of the person or the person's surrogate

is to be followed so long as it does not contradict Catholic principles. (no. 28)

  

   The free and informed judgment made by a competent adult patient concerning the use or withdrawal of life-sustaining procedures should always be respected and normally complied with, unless it is contrary to Catholic moral teaching. (no. 59)   (3) 

     The Ethical and Religious Directives for Catholic Health Care Services also makes explicit mention of advance directives and of the content of the Durable Power of Attorney for Health  Care in particular, noting the requirement that these documents be used to make decisions in conformity with Catholic teaching: 

In compliance with federal law, a Catholic health care institution will make available to patients information about their rights, under the laws of their state, to make an advance directive for their medical treatment.  The institution, however, will not honor an advance directive that is contrary to Catholic teaching. (no. 24)  

 

Each person may identify in advance a representative to make health care decisions as his or her surrogate in the event that the person loses the capacity to make health care decisions.  Decisions by the designed surrogate should be faithful to Catholic moral principles and to the person's intentions and values, or if the person's intentions are unknown, to the person's best interests.  (no. 25)    (4) 

 

    For presentation of the Catholic moral tradition on issues of death and dying, see the entries GENERAL POLICY ON THE USE OF LIFE-SUSTAINING TREATMENTS and EUTHANASIA AND ASSISTED SUICIDE, 

1. Pius XII, Address to an International Congress of Anesthesiologists, November 24, 1957; reprinted in Russell E. Smith (ed.), Conserving Human Life (Braintree, MA: Pope John Center, 1989). 

2. Congregation for the Doctrine of the Faith, Declaration on Euthanasia, IV (Washington, DC: United States Catholic Conference, 1980). 

3. National Conference of Catholic Bishops, Ethical and Religious Directives for Catholic Health Care Services (Nov. 1994) (Washington, DC: United States Catholic Conference, 1995). 

4. Ibid.

 COMMENTARY
ADVANCE DIRECTIVES

 The Living Will 

The first type of advance directive which was developed is the living will. As revised in 1992 (1), the living will for Iowa states: "If I should have an incurable or irreversible condition that will result either in death within a relatively short period of time or a state of permanent unconsciousness from which, to a reasonable degree of medical certainty, there can be no recovery, it is my desire that my life not be prolonged by the administration of life-sustaining procedures. If I am unable to participate in my health care decisions, I direct my attending physician to withhold or withdraw life-sustaining procedures that merely prolong the dying process and are not necessary to my comfort or freedom from pain." 

A living will goes into effect only when two conditions hold: 1) the patient is terminally ill  and 2) the patient is no longer able to make decisions about his/her health care (i.e., is incompetent). According to the Iowa Code, a "terminal condition" is "an incurable or irreversible condition that, without the administration of life-sustaining procedures, will, in the opinion of the attending physician, result in death within a relatively short period of time or a state of permanent unconsciousness from which, to a reasonable degree of medical certainty, there can be no recovery" (144A.2, subsection 8). A living will does not go into effect when a patient is in an emergency situation from which he/she may be expected to recover with proper treatment. 

According to the Iowa Code, a life sustaining procedure is "any medical procedure, treatment or intervention which meets both of the following requirements: (a) Utilizes mechanical or artificial means to sustain, restore, or supplant a spontaneous vital function; (b) when applied to a patient in a terminal condition, would serve only to prolong the dying process." (144A.2, subsection 5). This includes the provision of nutrition and hydration only when they are provided intravenously or through a tube feeding. (144A.2, subsection 5). "Life-sustaining procedure" does not include "the administration of medication or performance of any medical procedure deemed necessary to provide comfort care or to alleviate pain" (144A.2, subsection 5) . 

Changes were enacted in Iowa's living will law during the spring of 1992 (viz., 74th General Assembly, House File 2207). Formerly, artificial nutrition and hydration and a state of permanent unconsciousness were not included in the scope of the living will. The legislative changes also placed restrictions on the witnesses for a living will document, and allow a living will document to be notarized instead of witnessed. These changes establish consistency between the procedure for executing a living will and the procedure for executing a durable power of attorney for health care. 

With respect to living will documents executed prior to the 1992 legislative changes, the following provisions hold: 

1) A living will document executed prior to the current legislation remains valid, but will be applied in accordance with the legal provisions in effect at the time the document was executed. Thus, if a living will was previously executed according to the "standard form" in use, artificial nutrition and hydration and a state of permanent unconsciousness will still not be covered by that document. 

2) If a "non-standard" form was previously executed which included provisions now part of Iowa's living will law (viz., regarding artificial nutrition and hydration and/or a state of permanent unconsciousness), that document will be applied in accordance with those provisions. (See Iowa Code 144A.12). 

Legally, individuals who executed a living will document prior to the current legislative changes have the option of revoking that document and signing the new living will form. 

It should be noted that Iowa's Life-Sustaining Procedures Act, which legally establishes a living will for the state, contains an explicit disavowal of euthanasia: "This chapter shall not be construed to condone, authorize or approve mercy killing or euthanasia or to permit any affirmative or deliberative act or omission to end life other than to permit the natural process of dying" (144A.11, 6).  Further the Act specifies that a living will declaration which has been made by a woman now pregnant "shall not be in effect as long as the fetus could develop to the point of live birth with continued application of life-sustaining procedures" (144A.6, 2).  The same prohibition against the withholding or withdrawal of life-sustaining treatments is explicitly applied to the case of a pregnant woman who has never signed a living will (144A.7, 3).  Nevertheless, the protection legally accorded a fetus is not absolute, as the following qualification is added to both of these stipulations: "However, the provisions of this subsection do not impair any existing rights or responsibilities that any person may have in regard to the withholding or withdrawal of life-sustaining procedures" (144A.6, 2; 144A.7, 3). 

The Durable Power of Attorney for Health Care 

Because of limitations inherent in a living will, another form of advance directive has been developed, namely, the durable power of attorney for health care. 

The language of a living will document gives only general directives about life-sustaining treatments. When signing such a document, an individual cannot foresee and take into account the specific and particular conditions which will prevail when the use of life-sustaining treatments becomes an issue in his/her own case. In order to provide for more nuanced decisionmaking, a durable power of attorney for health care may be executed. By this document, an individual legally designates someone to make treatment decisions on his/her behalf when he/she is no longer competent to do so. The legally designated proxy (called the attorney in fact or agent) represents the patient in the give-and-take of discussing medical alternatives. The proxy should be someone who knows well the patient's values and preferences, and who can make decisions as the patient would if he/she were competent. The proxy may be a relative, but need not be. 

Further, the durable power of attorney for health care has been developed in a way that is broader in scope than the living will. A durable power of attorney for health care goes into effect in any situation in which the patient becomes incapable of making treatment decisions; in other words, it is not limited to cases of terminal illness. And if a patient should later regain decisionmaking capacity, the power to make medical treatment decisions reverts to the patient himself/herself. 

The legislation which established a durable power of attorney for health care in the State of Iowa protects not only the right to refuse treatment but also the right to request treatment: "This document gives my agent power to make health care decisions on my behalf, including to consent, to refuse to consent, or to withdraw consent to the provision of any care, treatment, service, or procedure to maintain, diagnose, or treat a physical or mental condition" (144B.5, 1; italics added). 

With respect to the decisionmaking process of the legally designated proxy, the law specifies that "In exercising the authority under the durable power of attorney for health care, the attorney in  

fact has a duty to act in accordance with the desires of the principal as expressed in the durable power of attorney for health care or otherwise made known to the attorney in fact at any time" (144B.6, 2).  Further, the law provides that if the patient's "desires are unknown, the attorney in fact has a duty to act in the best interests of the principal" (144B.6, 2).   These stipulations are in accord with the principles for proxy decisionmaking set out in the Ethical and Religious Directives for Catholic Health Care Services. (2) 

The legislation establishing a durable power of attorney for health care for the State of Iowa is likewise in accord with Catholic teaching in containing an explicit disavowal of euthanasia: "This chapter shall not be construed to condone, authorize, or approve any affirmative or deliberate act or omission which would constitute mercy killing or euthanasia" (144B.12, 2). 

It is important to keep in mind that a durable power of attorney for health care is a different legal document than a power of attorney for financial matters. The individual designated to take care of someone else's finances does not automatically have the power to make medical decisions for that individual. (3)

 

The Patient Self-Determination Act 

Federal legislation, called the Patient Self-Determination Act, has established requirements for healthcare providers with respect to advance directives. These requirements apply to Medicare providers (viz., hospitals, skilled nursing facilities, home health agencies, hospice programs, Medicare HMOs) and Medicaid providers (viz., hospitals, skilled nursing facilities, providers of home healthcare or personal care services, hospice, HMOs). The provisions apply to all adult individuals receiving medical care by or through the provider or organization. 

The Patient Self-Determination Act sets the following requirements for facilities covered by the Act: 

1)     Written information to each individual concerning an individual's rights under state law (whether statutory or as recognized by the courts of the state) to make decisions concerning medical care, including the right to accept or refuse medical or surgical treatment and the right to formulate advance directives. 

2)     Written policies of the provider or organization respecting the implementation of such rights. 

3)     Inquiry as to whether a person has an advance directive. 

4)     Documentation in the patient's medical record whether the individual has executed an advance directive. 

5)     Non discrimination, that is, not to condition the provision of care or otherwise discriminate against an individual based on whether the individual has executed an advance directive. 

6)     Compliance with requirements of state laws respecting advance directives at facilities of the provider or organization. 

7)     Provision for education of staff and community on issues concerning advance directives. 

 

The Patient Self-Determination Act also specifies the time at which the aforementioned information must be provided: 

--- in the case of a hospital, on an inpatient's admission; 

--- in the case of a nursing care facility, on the resident's admission

--- in the case of a home health agency, before the client comes under the care of the agency; 

--- in the case of hospice, when the patient receives initial hospice care; 

--- in the case of an eligible organization (e.g., HMO), when the client enrolls;
 

The law does not require a healthcare facility to agree to carry out any and all directives of a patient when appropriately executed through a living will or durable power of attorney for health care. No facility is required to act contrary to its mission and ethical values, even when the patient/resident requests this in writing. However, a facility must provide clearly written policies which specify the limits on the procedures it will perform. A clear summary of a facility's policies regarding advance directives and consent to/refusal of medical treatment must be available to the public. (4)

 

Need for Advance Directives 

In most cases, when an individual becomes incapacitated to make his/her own medical treatment decisions, these decisions can be made collaboratively by family members and healthcare professionals without difficulties occurring. However, there are cases where advance directives can be extremely helpful. 

Advance directives can be useful when conflicts arise among family members or between family members and healthcare providers. In such instances, if a durable power of attorney for health care has been executed, the designated agent legally has the power to make the final decision and bring the conflict to resolution. The statements contained in an advance directive can be taken as good evidence of an individual's wishes regarding life-sustaining treatments. Executing advance directives can prevent conflicts from going to court for resolution. 

A healthcare provider may be reluctant to withhold or withdraw life-sustaining treatments for fear of being sued. However, if an advance directive has been executed and the healthcare provider acts in accordance with it in not providing life-sustaining treatments, the healthcare provider is legally protected. Thus, advance directives can make healthcare providers more comfortable about complying with requests to forgo life-sustaining treatments. 

It should be noted that the Patient Self-Determination Act does not require anyone to execute advance directives, but only requires that patients be informed that these documents are available for use. 

 

Executing Advance Directives 

Forms and instructions for executing advance directives can be obtained from health care facilities or from attorneys. The Iowa Catholic Conference has developed a form for a durable power of attorney for health care; in the Archdiocese of Dubuque, this form may be obtained from the Archdiocesan office for health care. The Archdiocesan Medical-Moral Commission has also developed a form for the durable power of attorney for health care which places this document in a Christian faith context. A copy of this form, with accompanying instructions, is appended.


Substitute Medical Decision-Making Board 

Chapter 135.28-9 of the Iowa Code has created a State Substitute Medical Decision-Making Board and allows counties to establish Local Substitute Medical Decision-Making Boards. The general role of the local board is to act as a substitute decision maker for patients incapable of making their own medical care decisions and who do not have another substitute decision maker available. In other words, these boards are to act on behalf of individuals who are incapable of making their own medical treatment decisions and who do not have an agent designated through a durable power of attorney for health care, or a legal guardian, or family members available, willing, and able to serve as proxy decisionmakers.  

l. See Iowa Code chapter 144A.  

2. "Decisions by the designated surrogate should be faithful to Catholic moral principles and to the person's intentions and values, or if the person's intentions are unknown, to the person's best interests." National Conference of Catholic Bishops, Ethical and Religious Directives for Catholic Health Care Services (Nov. 1994) (Washington, DC: United States Catholic Conference, 1995), no. 25. 

3. The State of Iowa does have available a power of attorney through which the same person can be designated to handle both finances and health care decisions for another individual. It is important to keep in mind, however, that the power of attorney for financial affairs alone does not give power to make health care decisions. 

4. Catholic Health Association, The Patient Self-Determination Act An Educational Resource (St. Louis: Catholic Health Association, 1991), pp. 5-6. 

 

 

 

 

DURABLE POWER OF ATTORNEY FOR HEALTH CARE 

                FOR 

 

Name:___________________________________________________________

 

CHRISTIAN AFFIRMATION OF LIFE 

Life is a gift of God which I treasure and wish to live to the fullest. As a person created by God and in God's image, I have dignity and value. My life has been given to me as a sacred trust. I do not have absolute dominion over it but need to take reasonable care of it. 

As a Christian, I believe that death is part of life, that through death life is changed, not taken away, and that death need not be resisted by every possible means. By not unduly prolonging life, I can attest to my belief in eternal life. 

I am free legally and morally to choose the course of treatment that is best for me, taking into consideration the benefits to be gained, the burdens to me or to others and the risks involved for each treatment. 

Since I cannot foresee situations that may arise in regard to my health, I am choosing an agent who knows me and who can speak on my behalf should I become incapable of making my own decisions.





 DURABLE POWER OF ATTORNEY FOR HEALTH CARE DECISIONS

CREATION OF POWER OF ATTORNEY FOR HEALTH CARE 

I, the Principal, hereby designate____________________________________________________                 

 
                                First Name                                        Last Name

______________________________________________________________________________

(Type or Print)  Street Address                         City                                          State            Zip Code

 as my attorney in fact (my agent) and give to my agent the power to make health care decisions for me. This power exists only when I am unable, in the judgment of my attending physician, to make those health care decisions. The attorney in fact must act consistently with my desires as stated in this document or otherwise made known. 

Except as otherwise specified in this document, this document gives my agent the power, where otherwise consistent with the laws of the State of Iowa, to consent to my physician not giving health care or stopping health care which is necessary to keep me alive. 

This document gives my agent power to make health care decisions on my behalf, including to consent, to refuse to consent, or to withdraw consent to any care, treatment, service, or procedure to maintain, diagnose, or treat a physical or mental condition. This power is subject to any statement of my desires and any limitations included in this document. My agent has the right to examine my medical records and to consent to disclosure of such records. 

 

SPECIFIC INSTRUCTIONS AND STATEMENT OF DESIRES 

NOTE: The Principal does not have to give any specific instructions or statement of desires but may do so.

      Insert here specific instructions or statement of desires of principal (if any). Additional sheets may be attached.

  

 

DESIGNATION OF ALTERNATE HEALTH CARE AGENT

 NOTE: The Principal may designate one or more alternates as attorney in fact but does not have to do so. 

If the person designated above is unable to serve,

 

I designate_____________________________________________________________________

 (Type or print)            First Name                                                              Last Name

 

______________________________________________________________________________

(Type or Print) Street Address                         City                                                                  State                        Zip Code

 

to serve as my attorney in fact. 

Signed this_________ day of_______________, 19____.

 

________________________________________________________________

Signature of Principal (Person Granting the Power of Attorney) 

________________________________________________________________

 Type or Print Name of Principal 

________________________________________________________________

Street Address 

________________________________________________________________

City                                                            State                                        Zip Code

 

 This Power of Attorney must either be witnessed by two persons OR notarized.
       NOTARY PUBLIC 

STATE OF IOWA, __________________________________County, ss: 

On this_____ day of_______________ , A.D. 19____. before me, the undersigned, a Notary Public in and for the State of Iowa, personally appeared _________________________________

to me known to be the person named in and who executed the foregoing instrument, and acknowledged that (he)(she) executed the same as (his)(her) voluntary act and deed. 

____________________________________________________________

 Notary Public in and for the said State

OR 

STATEMENT OF TWO WITNESSES 

I know the principal personally and I believe him or her to be of sound mind and at least 18 years of age. I believe that his or her signing of this power of attorney is voluntary. I am at least 18 years of age. I am not a health care provider for the principal at this time                                                           

___________________________________                          ___________________________________ 

Signature of 1st Witness                                                Signature of 2nd Witness

 

___________________________________                 ___________________________________ 

Type or Print Name of Witness                                    Type or Print Name of Witness

 

___________________________________              ____________________________________

Street Address                                                             Street Address

 

____________________________________            ____________________________________

City                              State             Zip Code                City                              State            Zip Code

 

 

  

 

This is a legal document. Although it can be completed without a lawyer, do not sign it unless you clearly understand what it means. You may want to consult a lawyer if you have any questions.

                                                                                          c 1991 Medical-Moral Commission
                                                                                                Archdiocese of Dubuque                                                                                                                 Dubuque, Iowa

 

                                         

                 

                                                                                          This form may be reprinted.

GENERAL INFORMATION ON THE DURABLE POWER OF ATTORNEY FOR HEALTH CARE 

LEGAL INFORMATION 

A durable power of attorney for health care is subject to the provisions of Chapter 144B of the Code of Iowa and reference should be made to that chapter. The following is a summary of some of the provisions of Chapter 144B of the Code of Iowa. 

1.  Definition of "Health Care" and "Health Care Provider" 

An attorney in fact (agent) has the power to make decisions about "health care," meaning any care, treatment, service, or procedure to maintain, diagnose, or treat an individual's physical or mental condition. This includes the provision of nutrition or hydration only when they are provided intravenously or through a tube feeding. "Health care provider" means a person or health care facility licensed or certified to administer health care in the ordinary course of business or practice of a profession. 

2.  Witnessing 

      Witnessing may be done in two ways:  A Notary Public   OR   Two Witnesses. 

      a.  The following individuals shall not be witnesses for a durable power of attorney for health care:     

1)  A health care provider attending the principal (signer) on the date of the signing of this document.

2)  An employee of a health care provider attending the principal on the date of the signing   of this document.

     3)  The individual designated in the durable power of attorney for health care as the attorney                                           in fact (your agent).

4)  An individual who is less than eighteen years of age. 

      b. One of the witnesses shall be an individual who is not a relative of the principal by blood, marriage, or adoption within the third degree of blood relationship.

 

3. Attorney in fact (the agent designated as proxy decisionmaker) 

The following individuals shall not be designated as the attorney in fact (agent) to make health care decisions under a durable power of attorney for health care: 

      a. A health care provider attending the principal (signer) on the date of signing. 

      b. An employee of a health care provider attending the principal on the date of signing unless the individual to be designated is related to the principal by blood, marriage, or adoption within the third degree of blood relationship. 

Although there is no legal requirement to do so, it is advisable for the principal to ask the individual s/he wishes to designate as the attorney in fact (agent) about his/her willingness to serve in this capacity before executing the durable power of attorney for health care. 

 

4. Revocation 

      a. A durable power of attorney for health care may be revoked at any time and in any manner by which the principal is able to communicate the intent to revoke, without regard to mental or physical condition. 

      b. Revocation may be made by notifying the attorney in fact (agent) orally or in writing. See also (d) below.

      c. Revocation can also be made by notifying a health care provider orally or in writing while that provider is engaged in providing health care to the principal. 

      d. A revocation is only effective as to a health care provider upon its communication to the provider by the principal or by another to whom the principal has communicated revocation. 

      e. The health care provider is required to document the revocation in the treatment records of the principal. 

      f. The principal is presumed to have the capacity to revoke a durable power of attorney for health care. 

      g. Unless it provides otherwise, a valid durable power of attorney for health care revokes any prior durable power of attorney for health care. 

5. Prohibited Practices 

      a. A health care provider, health care service plan, insurer, self-insured employee welfare benefit plan, or nonprofit hospital plan shall not condition admission to a facility, or the providing of treatment, or insurance, on the requirement that an individual execute a durable power of attorney for health care. 

      b. A policy of life insurance shall not be legally impaired or invalidated in any manner by the withholding or withdrawing of health care pursuant to the direction of an attorney in fact appointed pursuant to this chapter. 

6. Notification 

It is the responsibility of the principal to notify the health care provider of the terms of the durable power of attorney for health care. 

When the document has been signed, it is advisable (although not legally required) to notify the attorney in fact (agent) that the document has been executed.

 

 

 

INFORMATION REGARDING SPECIFIC INSTRUCTIONS AND STATEMENT OF DESIRES 

Completing this section of the form is optional. The principal may document in writing wishes and instructions regarding medical treatments which will guide and legally bind his/her agent. 

Instructions of a general character may be included in this section of the document, such as the following directives: 

I want life-sustaining treatment provided only if the probable benefits of treatment outweigh its anticipated pain, discomfort, or other burden. 

If I should have an incurable or irreversible condition that will cause my death within a relatively short time, it is my desire that my life not be prolonged by administration of life-sustaining procedures. In these circumstances I want procedures withheld or withdrawn that merely prolong my dying process and are not necessary to my comfort or freedom from pain. 

In addition, more specific instructions may be included regarding particular procedures such as a Do Not Resuscitate order, intravenous or tube feeding, use of a ventilator (breathing machine), dialysis, antibiotics, or the provision of adequate pain medication (even if it has a secondary effect of hastening the moment of death). The instructions given should be consistent with each other. 

In this section of the document the principal may make provision for organ donation, or include stipulations of a specifically religious character (e.g., Health care decisions made on my behalf should be made in accordance with the moral teachings of the Catholic Church; If at all possible, I wish to receive the sacraments before my death). 

When executing a durable power of attorney for health care, an individual cannot foresee and take into account all the specific and particular conditions which may hold when the document takes effect. Thus it is prudent to leave room for the agent to exercise his/her discretion about medical treatments. Written instructions are appropriate if the principal has strong feelings about using or forgoing particular treatments. Written instructions, whether general or specific, may also be used as a way of assuring healthcare providers and others that decisions likely to be made by the agent are in fact in accord with the wishes and desires of the principal. 

Suggestions after the Form is Properly Signed and Witnessed or Notarized 

It would be well to place the original in a safe place known and accessible to family members or close friends. 

Give copies of the original to your physician, your agent and alternates, and family members. 

Discuss with your physician and agent your values and wishes that can be used as guidelines to fulfill your expectations as closely as possible. 

Note:

This document is more comprehensive than a living will. While a living will becomes effective only when the principal is incapable of making health care decisions and is terminally ill, the durable power of attorney for health care becomes effective whenever the principal becomes incapacitated to make his/her own decisions.                                                                                                                                                    

Revised      July 1992

 


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