Caregiving

The ABCs of Living Wills and Health Care Proxies

Introduction

Ordinarily, when you go to a physician for medical care, you and your physician discuss your treatment options and you decide which treatments, if any, you wish to undergo. The law recognizes that if you are an adult of sound mind, neither your physicians nor anyone else may treat you without your consent. This is true even if the treatments are necessary to keep you alive.

There are occasions where some people, because of their personal, religious or other beliefs, the nature of their illnesses, or the nature of proposed life-sustaining treatments, would choose to forgo such treatments. For example, many people feel that if they were to fall into an irreversible coma with no hope of recovery, they would rather be permitted to die than be hooked up to respirators and other machines indefinitely.

Unfortunately, when decisions about life-sustaining treatment have to be made, people are often in no condition to express their treatment wishes. Without evidence of such wishes, some state laws make it very difficult to stop life-sustaining treatments even if family members or close friends believe that the patient would have wanted such treatments stopped.

A good example of this is a case involving twenty-five year old Nancy Cruzan. In 1983, Nancy was severely injured in an automobile accident and lost her mental faculties. To keep her alive, the hospital hooked her up to equipment that provided her artificial nutrition and hydration. After learning that Nancy had almost no chance of regaining consciousness and recovering her mental abilities, Nancy's parents asked a court to permit them to disconnect the nutrition and hydration equipment. The court refused to do so, even though there was evidence from one of Nancy's friends that Nancy would not have wanted to be kept alive under these circumstances. The court found this evidence insufficient as the state law required clear and convincing evidence of Nancy's wishes.

Fortunately, all states have created mechanisms, known as advance directives, through which you can help to assure that your treatment preferences will be known and acted upon even if you are incapacitated when medical decisions have to be made. Two such mechanisms are living wills and health care proxies.

Living Wills

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