Pine Valley

Your right to make health care decisions
under the law in Wisconsin

Wisconsin and Federal law give every competent adult, 18 years or older, the right to make their own health care decisions. You have the right to decide what medical care or treatment to agree to, to reject or to end. If you do not want to receive certain types of treatments, or want to name someone to make health decisions, you have the right to make these desires known to your health care providers, and to have these rights respected. You also have the right to be informed about the nature of your illness in terms that you can understand, the general nature of the proposed treatments, the risks of failing to undergo these treatments and any alternate treatments or procedures that may be available to you. However, there may be times when you cannot make your wishes known to your doctor or other health care providers. For example, if you were taken to a hospital in a coma, would you want the hospital’s medical staff to know what your specific wishes are about the medical care that you want or do not want to receive?

WHAT ARE ADVANCE DIRECTIVES?

Advance Directives are documents that allow you to state your choices and wishes about medical and health care decisions. The advance directives make it easier for family members to understand what you could want during a difficult situation. Advance Directives take effect only when you can no longer make your own health care decisions. These decisions might include issues such as CPR (Cardio-pulmonary resuscitation), surgery, ventilator, kidney dialysis or a feeding tube. If you can give informed consent your health care providers will rely on you and not on your advance directives.

Advance Directives can either be a Power of Attorney for Health Care or a Living Will.

Take the time to make your health care decisions known in advance.

Living Will

The Living Will is written instructions that inform physicians and your family members what life-sustaining treatment you do or do not want if you become unable to make health decisions. It is limited, however, because it can only be carried out if you are considered terminally ill. Two physicians must agree (in writing) that you are either near death or in a vegetative state that cannot be reversed. Therefore, it may not be accepted in situations such as Alzheimer’s Disease without a terminal illness.

Advantages of Living Wills

The Living Will document states directly to physicians what you want, and under what circumstances. It deals specifically with “end of life” decisions, a terminal illness or persistent vegetative state. It may help family members feel confident in making the decision since preferences are specifically listed.

Disadvantages of Living Wills

If not found in the medical file, may never be known, There is no advocate to make sure the document is followed. It applies in very limited circumstances.

The Power of Attorney for Health Care

The Power of Attorney for Health Care allows an adult, the principal, to appoint another person(s) to make his/her health care decisions. The person appointed is called an agent. An agent can make decisions only when the principal is found incapable of making medical decisions by two physicians or a physician and a psychologist (unless the principal waives this requirement and appoints another method of finding incapacity). The first agent will be contacted initially. If they cannot be reached, or waive their authority, the second agent is then contacted. Agents cannot be given authority under the statute to admit the principal to a mental institution or to consent to certain types of psychiatric treatments. Agents may be given authority to make decisions about long-term placement in a nursing home or residential facility and about tube feedings. These specific powers are outlined in the Power of Attorney for Health Care document and should be clearly answered yes or no. Failure to record an answer means, under the law, that the answer is no. An agent is allowed to make other decisions based on conversations with the principal, on written instructions, or on what is judged to be the principal’s best interests.

Health care agents do not have any authority to make health care decisions until it is decided that the patient (Principal) is incapable of making his or her own decisions. If someone is appointed only as a power of attorney for financial matters, they do not have authority to make decisions for health.

Common Concerns

Do I need both documents?

It is recommended that you have either a Power of Attorney of Health Care or a Living Will. The presence of both documents can make it more difficult to interpret your wishes. Usually the Power of Attorney for Health Care is the preferred document. The Living Will is a written document directing the PHYSICIAN to make the decision. The Power of Attorney for Health Care appoints the AGENT to make the decision. A Power of Attorney for Health Care is applicable for a greater number of procedures and more medical situations.

What kind of health care decisions does the Power of Attorney cover?

Almost anything. It is much broader than the Living Will that only covers two “procedures”: life sustaining equipment and a feeding tube. A Living Will only applies in two medical situations: terminal illness where death is imminent or where the individual is in a “persistent vegetative state”.

Power of Attorney for Health Care applies to all health care decisions when a person is incapacitated (temporarily in a coma and needs a decision about medication, surgery, the individual has dementia and needs a long term care decision made, or even if death is imminent, but decisions not just about life support, but amputation, surgery, etc.)

Advantages of Power of Attorney for Health Care

1. Covers more situations than the Living Will.
2. Provides a live person to serve as an advocate, a spokesperson.
3. An agent can deal with changing prognosis and diagnoses, by meeting health care providers.
4. Gives health care providers one individual to turn to.

Disadvantages of Power of Attorney for Health Care

1. If the agent disagrees with preferences, may not be a good advocate.
2. If family disagrees with agent’s decisions, may cause problems.
3. An agent may be unavailable when needed or get “cold feet” and be unwilling to make needed decisions.

Who can make decisions for me?

You may choose anyone over the age of 18. Health care providers can be named only if they are relatives.

What if I change my mind?

You may cancel or replace either document any time, simply destroy the original and notify your physician, hospital and anyone who has copies of your document.

What if I do not have an Advance Directive?

The presence of an Advance Directive helps ensure your wishes are honored. You will receive medical care even if you do not have an Advance Directive. In this situation your physician will look to family, friends, or clergy for decisions about your care, if you are unable to make them for yourself.

Do I need an Advance Directive to enter a nursing home? In Wisconsin, a competent adult can voluntarily admit himself to a nursing home. If you are no longer competent, a court appointed guardian and protective placement must be obtained. With a Power of Attorney for Health Care, you can give permission to your agent to make this decision, avoiding the need to establish guardianship.

Before you complete the Power of Attorney for Health Care read the entire document carefully. Be sure you understand the authority you are giving to someone else. Think carefully about whom you want to select as your agent. You may not select your doctor, nurse, an employee of your health care facility or spouse of any of these individuals, UNLESS this individual is also a relative. Consider a close family member or friend – someone who knows you well, who lives geographically close to you, who will be a strong advocate for you and will ensure that your preferences are honored. Talk to that individual about your health care preferences, religious beliefs, quality of life concerns, etc. Ask the individual if he/she will accept this responsibility. Do the same with your alternate agent.

COMPLETING THE POWER OF ATTORNEY FOR HEALTH CARE FORM

PRINT your name and address and date of birth after the “I”. PRINT the name, address and phone number (include area code) of the individual you have selected as your health care agent. If the individual is a relative, indicate the relationship (daughter) in the parentheses, after the name. PRINT the name, address and telephone number of the individual you have selected as an alternate agent. Remember, you may only appoint ONE individual as agent and ONE as the alternate agent.

Under Admission to Nursing Homes or Community-Based Residential Facilities, decide whether you want your agent to have authority to admit you to a nursing home or community-based residential facility, If you check YES, your agent can do so without going to court. That will same time, money and emotional anguish for you and your family. On the other hand, the court process is designed as protection for you, to ensure that you really need to be in a nursing home. Decide whether you are comfortable giving that power to your agent. If you check NO, or leave the question blank, or your agent will not have that authority and a court hearing will be required before you could be admitted to a nursing home if you are not competent at the time.

Under the Provision of Feeding Tube, decide whether you want your agent to have authority to withhold or withdraw feeding tubes. If you check YES, your agent will have the authority to decide, on a case-by-case basis, whether you would want him or her to withhold or withdraw these feeding tubes. If you check NO, or if you leave it blank, your agent would have to get a court order before doing so.

The Health Care Decisions for Pregnant Women section applies only to women who can become pregnant. If you are a man or a woman who is incapable of becoming pregnant, write NOT APPLICABLE next to the blanks. If you could become pregnant, decide whether you want your agent to have that authority. There are decisions that a health care agent might have to make. If you are in a car accident while pregnant and left unconscious, someone has to decide whether to set broken bones and make other decisions. Again, if you check NO, or leave it blank, your agent will not have the authority to make decisions for you if you later become pregnant.

Under Statement of Desires or Limitations you are encouraged to add something to personalize the form. Print all inserts. This is also the place to clarify, put limitations on, or further explain any of the earlier “YES” or “NO” questions. If you have more to insert than fits in the spaces, use a separate sheet, titled “Addendum to the Power of Attorney for Health Care of (your name). Then print (or type) your additional provisions. This Addendum should be signed and witnessed exactly like the document itself.

For the signing, you and your two witnesses must be together. A witness may not be: your agent, a person with a claim on your estate, a relative, someone directly financially responsible for your health care, your health care provider, an employee of your health care provider or an employee of the health care facility in which you live. However, a person employed as a chaplain or social worker by your health care provider or health care facility may be a witness. In the presence of the witnesses, you should then date the form. Have your two witnesses then sign the form. If your agent and/or alternate agent are not present, you should then take or mail the form to them for their signatures. Insert your own name in the first two blanks under Statement of Health Care Agent and Alternate Health Care Agent.

Anatomical Gifts

This section is optional, you can make decisions regarding organ donations.

After it is completed – give copies to you agent, your alternate agent, your physician, your hospital, keep a copy in a safe place at home. Discuss with close family members.

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