Medical Directives

One of the most important documents necessary to avoid court involvement when you are old and funny is a Durable Power of Attorney for Health Care also called a Designation of Patient Advocate. With this document, you choose who is going to make your medical decisions when you are unable and you specify the guidelines for them to use in making those decisions.

One major medical decision is when to pull the plug? Do you want the court to decide? In Michigan, you can avoid probate court involvement in such situations. However, you must specifically express in a clear and convincing manner in your Durable Power of Attorney for Health Care that your Patient Advocate can make decisions to withhold or withdraw treatment that could or would lead to your death.

Without written directives that you put in place, multiple family members may end up petitioning the Probate court to make this decision. These parties rarely agree. Do you remember the Terry Schiavo case in Florida several years ago? Would you like that to be you and your family? Whatever your position on the use of life support, now is the time to say what you want.

There is a wide spectrum of directives that you can have regarding end-of-life treatment. On one end of the spectrum, you could say keep me alive no matter what, even if I am a complete vegetable. I have had only one person in over 20 years request to be kept alive under any circumstances.

On the other end of the spectrum would be the no code or do not resuscitate (“DNR”) order. With a do not resuscitate order, you request that you do not want to have any type of resuscitation under any circumstances. Even if you have a minor heart attack, you want no resuscitation and want to be allowed to die with dignity and let God’s will be done. Usually the persons who request a do not resuscitate order already have some debilitating or terminal illness or disease.

Most people are in the middle of the road and only want artificial means to be withheld or withdrawn if they are in an irreversible coma or persistent vegetative state, are terminally ill and artificial means only prolong the dying process or where the burdens of treatment outweigh the benefits.

You can have almost unlimited variations. Some people may not want life support removed unless they have been in one of the above situations more than six months.

Whatever your wishes, as long as they are set forth in a clear and convincing manner, you could put down just about anything that you want. I have had dialysis patients request that upon their mental disability, that dialysis be discontinued, knowing full well that without dialysis, their body would not last but a few days.

I have had cancer survivors who have indicated that in the event of a cancer reoccurrence during their mental disability, they do not want their body to be put through chemotherapy again. Its all up to you. You have the right to determine your own fate.

You also should indicate what you consider “artificial” means. Is receiving food and water through tubes or breathing with the aid of a machine considered artificial to you? You decide.

I have many people ask me how they can be assured that their wishes are going to be followed by the hospital or other medical care providers. Fortunately, the courts have made decisions that raise the comfort level that your final wishes are going to be followed. The possibility of a multi-million dollar verdict against a hospital which keeps you alive contrary to your written wishes is a strong incentive to follow your final directives.

By: Matthew M. Wallace, CPA JD

Published edited February 15, 2009 in The Times Herald newspaper, Port Huron, Michigan as: Your death is your decision

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