National Healthcare Decisions Day

Learn About Living Wills

April 13, 2016

Everyone has a say in their health – even when they cannot speak for themselves.

That is why we must take the time to let people know what our wishes are.

In Pennsylvania, if something occurs where you cannot speak for yourself, the law states medical staff must make decisions based on the following in this order:
• Living will instructions;
• Directions from a patient-appointed health-care power of attorney;
• A close family member or other representative designated by the patient or the law itself. The law defines which relationships get priority if no one is designated.

Are you prepared? Do you have written instructions so your loved ones don’t have to worry? In Pennsylvania, you do not need an attorney to have this done.

April 16 is National Healthcare Decisions Day. Penn Highlands Healthcare is participating in this event by offering opportunities to meet with people who can answer questions about living wills and healthcare powers-of-attorney. They can make this serious topic a lot less scary to think about. Stop by at any of the following events where you can pick up information, including the official documents.

At Penn Highlands Elk, from 10 a.m. to noon and 2-4 p.m. Saturday, April 16, experts will be in the front lobby to answer questions and help in any way they can.

At Penn Highlands Clearfield, PH Clearfield Hospice will provide information on living wills and have the “Five Wishes” booklet to hand out in the lobby of the hospital from 10 a.m. to 2 p.m., Friday, April 15.

At Penn Highlands Brookville, information on living wills and advance directives will be at a table in the Outpatient Registration area all day on Friday, April 15.

In DuBois, the Ethics Committee of Penn Highlands DuBois will be at the DuBois Mall near Bath & Body Works from 10 a.m. to 1 p.m., Saturday, April 16.

What exactly are living wills? Living wills are written instructions for what patients want if they are unable to speak for themselves in a medical crisis. Living wills answer questions about your thoughts on care, such as tube feeding, dialysis, antibiotics, ventilators and CPR.

“A living goes into effect when the patient is determined by the attending physician to be incompetent, and the patient is permanently unconscious or has an end-stage medical condition,” Debra Thomas, RN, chief nursing officer at PH Brookville, said. That means a condition that you aren’t going to recover from.

“All adults 18 years of age and older, married or single, should complete a living will,” Judy Hixon, RN, PH Clearfield Hospice manager, said.

To be valid, a living will must be a written document that is dated and signed by the patient and two witnesses. If the patient cannot physically sign, someone can act on the patient’s behalf in front of the two witnesses. The patient, witnesses and any person acting on the patient’s behalf must be age 18 or older. Doctors and their office staff cannot witness on behalf of any patient that they are treating.

In Pennsylvania, living wills do not have to be notarized, but in some states, they do. This is something people who travel a lot may want to consider.

“You should keep your living will in an easily accessible location in your house, and/or even in the glove box of your car – some place you will not forget,” Matt Bridgman, PhD, neuropsychologist and chairman of the Ethics Committee at PH DuBois, said.

“Copies should also be made and given to your family doctor and any close family members, such as your parents or adult children. If you do not have a close family member, then provide a copy to a trusted friend or neighbor (whomever you would designate as your emergency contact person). Be sure to give updated copies to these folks if you ever change anything on your living will,” he said.

How long do these documents last? “Your living will is always valid as long as you signed it voluntarily and do not rescind it or declare it void. If you decide at any time to revoke any portion of the living will, you can. If you are in the hospital, communicate this to your attending physician, then execute a new living will,” Michele Patrick, social worker, Case Management at PH Elk, said.

But living wills aren’t your only option. Instead of having one’s wishes in writing, a person can make decisions on behalf of a patient as things happen. Adult patients can, at any time, appoint someone through a health care power of attorney legal agreement.

The health care power of attorney makes decisions when a person can no longer make decisions for themselves, as per the instructions of the power of attorney document. Some people prefer to have a health care power of attorney when they are competent, because they no longer want to make the decisions for themselves.

Since the people are appointed while a patient is still competent, the people chosen should know what the patient will want and how the patient feels about certain situations.

The best bet is to have both, a living will and a health-care power-of-attorney, incorporated into one document. That way all bases are covered in case something occurs that isn’t covered in the living will.

If no one is named, the law decides who makes decisions. Not just any family member can make decisions. It follows a specific order:
• Spouse and adult child who is not the child of the spouse;
• Adult child;
• Parent;
• Adult sibling;
• Adult grandchild;
• Close friend who knows the patient’s preferences and values.

The law states that the person making the decision has to be reasonably available. If he or she is not available, the next person on the list is contacted.

“If you want your wishes fulfilled,” Thomas said, “you must leave a document stating those wishes.” It makes it easier for families if things are in writing. “Children find it difficult to make those decisions for their parents,” she said. Being prepared can save families a lot of anguish.

It’s easy to take the first step in completing a living will for yourself. Stop by one of the locations mentioned above to get the forms and more information.