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Advance Directives Help Ensure Your Rights

Advance Directives Help Ensure Your Rights

Health Care Proxies Ensure Your Wishes Are Followed

By Julia C. Bonney

In 1991, New York State passed the Health-Care Proxy Law which allows a competent adult to delegate the authority to make health-care decisions, should he or she become unable to do so, to another adult.

The health-care proxy is a simple, yet powerful, tool. By appointing an agent to act on your behalf when you cannot, you help to ensure that your health-care wishes will be carried out. Among your rights as a patient are the right to participate in decisions regarding your course of treatment, and the right to accept or refuse medical or surgical intervention. You also have the right to formulate advance directives, such as the desire not to be put on life-support systems should your condition be diagnosed as irreversible.

How medical directives work

Appointing a health-care proxy to act on your behalf is not complicated; it does not require a lawyer or third-party assistance. It does require you to select an individual who knows you well and who will agree to act as your agent. We suggest that you select two individuals, a primary and a secondary health-care proxy, in the event that your primary agent is not able to act on your behalf. Typically proxies are spouses, significant others, adult children, or close friends: they should be people with whom you are comfortable talking about your beliefs and desires regarding health-care decisions and terminal illness. Having a conversation with your physician is also a very good idea.

Advance medical directives do not need to cover every possible medical scenario. The role of your health-care proxy is to represent your wishes and to take an active part in the decision-making process, based on information from the health-care provider responsible for your care. The best way to ensure this is for you to have a conversation about your preferences at a time when you are well, prior to the onset of any serious illness or injury.

In order for someone to act as your health-care proxy, you should have a signed, witnessed, advance directive in your medical records both at your primary care physician's office and at the medical center. Advance directive forms can be obtained at either place. To have one sent to you from Cayuga Medical Center, simply call (607) 274-4498.

We often find that families have not had these important discussions prior to hospitalization. In cases of extreme medical urgency, this can have a tremendous impact on the course of treatment. The most difficult and poignant situations involve decisions around life support. If the hospital or medical center has no advance directive naming a health-care proxy, and if there has been no previous conversation with the patient about his or her wishes, the removal of life support is extremely difficult. According to New York State law, life support cannot be discontinued without clear and convincing evidence of the patient's wishes, and without that evidence, the medical center is powerless to act. Moreover, your agent must know your specific wishes regarding the withholding or withdrawal of artificial nutrition and hydration. Under the law, hospitals are required to provide nourishment in the absence of evidence that such a course of treatment is contrary to the patient's wishes.

Everyone should have a proxy

Many people believe that advance directives are only for the elderly or terminally ill. In fact, every adult should have an advance directive in place. Life-threatening illness and injury that render patients temporarily incompetent can happen at any age.

People who work in acute health care see firsthand the benefit of advance directives. When families face difficult decisions regarding the care of a loved one, they are typically more comfortable with the decisions they make when an advance directive is in place. They have had conversations about these important issues with their loved one and know his or her desires regarding extreme measures, life support, the use of antibiotics, and a range of other questions that surface in the course of medical emergencies and terminal illness.

Caregivers at Cayuga Medical Center are making a concerted effort to talk with patients about advance directives. But in the best of all worlds, the hospital is not the time or place for these decisions. Talk to your family when you are well and under no pressure to make important life decisions. Your entire family will benefit.

Julia Bonney of Bonney Communications is a medical writer for Cayuga Medical Center.

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