The Advanced Healthcare Directive

None of us ever think about the consequences of having a massive stroke, heart attack, or other health related malady that leaves us in a position where we cannot make our own health related decisions. In many states, there are statutes in place which delineate (describe precisely) the family members who have the right to step into one's shoes in order to make a healthcare decision. If you are unable to do so, it is still always best to determine while you are in good health the person or those persons who would be best to step into your shoes and decide your health related future. Careful consideration must be given to one's family dynamics. This is particularly important if you do not have close lineal family members or if you are part of what is known as a blended family. Divorce is rampant in this country and literally half of all families have been melded together as a result of previous family breakups.

The first decision you should make is who do you want to act as your healthcare agent. If you have a family that gets along, it may be wise to select a number of your children to act as your health care agents. After all you may be visiting a child in a different locale when a health related problem strikes. I normally recommend that you name the family members that you desire to act either jointly or individually. You want to make it perfectly clear to your family that before they decide to pull the plug that you would like them to communicate with one another and be certain that they are all comfortable with the final decision. If you are dealing with a fractious family, you may want to avoid designating warring parties as co-healthcare agents. In those situations where you have a blended family you may want to make certain that both your spouse and your children concur with regard to your healthcare decision making and particularly on an ultimate death decision.

The healthcare directive should be very broad and flexible giving your family the opportunity to use experimental treatment, new technology and a broad array of medical strategies in order to make knowledgeable decisions on your behalf. If you are competent and can communicate, you always control your own healthcare decision making. You cannot be overruled by your healthcare agent unless you are deemed to be incompetent or incapable of making a cogent (clear and logical) health care choices. Make certain your document deals with long term care issues. The agent should be permitted to deal with home health care, adult day care, assisted living, nursing home and hospice care issues that may arise in the future. You must also decide when and if food, water, nutrition and medical treatment may be withheld given the state of your condition. It is better to give your healthcare agent flexibility to explore with the medical community the various options available to them rather than restricting their use of these broad based tools.

Consideration should also be given to the ability of the healthcare agent to interface and interact with your power of attorney. The person who holds the power of attorney controls the purse strings. If they don't buy into your healthcare strategy, your healthcare agent may develop a perfectly great strategy for your home care by way of example but the financial power of attorney may refuse to pay for the cost of care. On the other hand, it does help to have a check and balance with regard to these decisions. If one person is selected as both your power of attorney and health care agent it could put an unnecessary burden on that individual. By splitting the responsibility among various family members, you may actually reduce the stress and pressure that they may feel regarding the caregiving activity.


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