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Prostate Disorders Special Report

Planning Ahead: The Living Will and Durable Power of Attorney

If you have advanced prostate cancer, you may want to take the time now to make some important decisions about your future medical care, in case you are ever not able to make decisions for yourself. This Health Alert looks at two popular kinds of advance directives: a living will and a durable power of attorney for healthcare.

There are two types of advance directives: a living will and a durable power of attorney for health care. If you decide to provide advance directives, you may wish to have one or both types.

Advance Directive: Living Will. This advance directive explains your wishes for medical care in case you cannot communicate. A living will protects your rights to accept or refuse care, and it removes the burden of life-or death decisions from your family members or your medical team.

In your living will, you can state that you don't want to be kept alive artificially or to receive aggressive medical treatment to save your life, but you do not wish to refuse all medical care. For example, you may want to receive only palliative, or comfort, care to alleviate pain and suffering. A living will can also include your choices regarding issues such as:

  • Do not resuscitate (DNR) orders. Do you want to refuse cardiopulmonary resuscitation if your breathing or heartbeat stops?
  • Artificial feeding. If you're unable to eat or drink, do you want nutrients and hydration to be administered through a feeding tube or intravenously?
  • Artificial breathing. Do you want doctors to use life-sustaining equipment, such as a ventilator or respirator, if you are unable to breathe on your own?
  • Donating your organs. Laws about when a living will goes into effect and which medical interventions it applies to may vary from state to state. Ask your doctor, the hospital social worker, or your family lawyer to explain the law in your state.

Advance Directive: Durable Power of Attorney for Healthcare. Also known as a healthcare proxy, this advance directive names a person (sometimes referred to as a proxy) that you designate to make decisions regarding end-of-life care if you are unable to make them yourself. This person can also see to it that your wishes as described in your living will are carried out. Usually this is someone you know well and trust to make decisions that will represent your wishes in case they are not laid out in your living will.

Whether you choose a spouse, child, or trusted friend, your healthcare proxy should understand your wishes and values. Don't expect your proxy to read your mind -- have a long discussion with this person, explaining your thinking.

In some states, a healthcare proxy is allowed to make medical decisions for the patient only at the end of life, while in others he or she can make decisions at any time the patient is unable to do so. Again, check with your doctor, the hospital social worker, or your attorney about the laws in your state.

Once you have decided which advance directives you want, fill out the forms, and sign and date them in the presence of a competent adult witness (in some states two people must witness the signing) or a notary public. Keep copies of these advance directives at home and also include a copy in your medical records. Once signed, these documents are legal and binding.

It's not necessary to see an attorney to prepare these advance directives, but be sure that the forms you use conform to the laws in your state. Caring Connections, a program of the National Hospice and Palliative Care Organization (www.caringinfo.org; 800-658- 8898), has state-by-state information on advance directives. If you change your mind about any of your wishes, be sure to update all written instructions and share the changes with your healthcare providers and family.

Posted in Prostate Disorders on June 3, 2010

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