Advanced Medical Directives During Cancer Treatment
Do I need an Advanced Medical Directive?
Everyone should have an Advanced Medical Directive! For those touched by cancer, the disease and treatment bring added risks. Having an Advanced Medical Directive ensures you wishes are followed… even when you can’t speak for yourself. If this should happen, it would be helpful to have someone who knows your values and in whom you have trust to make important medical decisions for you.
An Advance Medical Directive (“AMD”), sometimes called a healthcare power of attorney, is a legal document indicating the level of medical treatment the patient wishes to receive if incapable of communicating. Within the document, the patient or Principle appoints someone, called the Agent, to act as the principal’s representative to communicate that level of treatment. Generally, an AMD takes effect when you become incapacitated.
How Do I use an Advanced Medical Directive?
An Advanced Medical Directive allows you to state what level of medical care you want. Specifically, you can direct that a specific procedure or treatment be provided, such as artificially administered hydration (fluids) or nutrition (feeding); direct that a specific procedure or treatment be withheld; and/or appoint a person to act as your agent in making health care decisions for you. In short, if you cannot make medical care decision, it says what medical care you do or do not want and names someone to make those decisions for you.
Here are some key areas that should be addressed in your Advanced Medical Directive:
- Cardiopulmonary Resuscitation (CPR): Treatment to restore breathing and heartbeat. It may include pushing on the chest, electric shock to the chest, and the insertion of a breathing tube in your throat.
- Dialysis: Treatment to clean the blood with a machine when the kidneys do not function.
- Breathing: Being placed on a ventilator or breathing machine.
- Nutrients: Giving food, water, and medication through tubes.
- Pain Management.
Who should be the agent?
Your life will be in the hands of another person of your choice. Your agent has decision-making priority over any other individuals who could, by law, make health care decisions for you. It essential the person you appoint as your agent understands what level of care you would want if you are unable to speak for yourself. Communication is at the heart of the relationship. Most people appoint their spouse as their agent and have had a discussion on medical care. However, a single older client might rely on a friend or relative to act as an agent, where an in-depth conversation has not occurred. If you do not communicate your wishes the agent might make the wrong decision on medical care.
The agent also has to be a person that can be trusted and must be someone that will make the right decision in accordance of your wishes. That must mean your agent should be mentally strong enough to say “no” to treatment when it is clear you would not want that treatment even if it merely prolongs your life but does not “cure” you.
It’s imperative that you communicate your wishes, values, and religious beliefs to the agent. Equally important, you should select an agent in whom you have trust and confidence. In the event your agent does not know of your wishes, that agent should be willing to make health care decisions based upon your best interests.
The following may not act as your agent:
- The principal’s health care provider,
- An employee of the health care provider unless the person is a relative of the principal,
- The principal’s residential care provider, or
- An employee of the principal’s residential care provider unless the person is the principal’s relative.
Do I need an attorney to complete my Advanced Medical Directive?
Most states have guidelines with respect to AMDs (ie. Texas, Virginia and Maryland). The guidelines give the basic types of procedures and treatments that a person would either want done to them or not done. However, they are only guidelines, and a client can draft an AMD to address almost any hypothetical treatment. Some people will even get down to specific types of cancer treatment that they want or do not want. The most popular procedure people address is whether to be intravenously fed while in a vegetative state, e.g. living like Terri Schiavo.
Even with prior talks, clear instructions to your agent in your AMD document are essential because the AMD will be the agent’s directives from you. A poorly drafted AMD, or one that gives the wrong person power, might result in being subject to an unwanted treatment or possibly your death.
Creating an AMD is a complex issue that sometimes requires asking difficult questions about end of life medical treatment and how your loved ones will react to those decisions. However, it will go a long way to giving you piece of mind you deserve.
If you cannot afford an attorney, here’s a sample document that might provide…
Inform key people of your preferences.
Notify your doctor, family and close friends about your end-of-life preferences. Keep a copy of your signed and completed advance health care directive safe and accessible. This will help ensure that your wishes will be known at the critical time and carried out. Give a copy to:
- The person you appoint as your agent and any alternate designated agents
- Your physician
- Your health care providers
- The health care institution that is providing your care
- Family members
- Other responsible person who is likely to be called if there is a medical emergency