nursing home abuse & neglect news

Advance Medical Directive: Planning Health Care

The following excerpt is from the beginning of a 2005 report “Planning Your Health Care in Advance” issued by Attorney General Eliot Spitzer, State of New York, about how important an Advance Medical Directive is for those entering the later stages of life.  In it, Spitzer speaks about many issues facing nursing home residents and, as we see below, the importance of an Advance Medical Directive. 

For more information, read our recent newsletter on what an Advance Medical Directive is and why it is important.

OVERVIEW: WHY PLAN IN ADVANCE?

It is possible that because of illness or injury, you may be unable to talk to a doctor and make decisions about your treatment. You may wish to plan in advance to help make sure that your wishes about treatment will be followed if you become unable to decide for yourself for a short or long time period. If you do not plan ahead, family members, loved ones or others you trust may not be allowed to follow your wishes by making decisions for you.

A few months after Ms. C suffered a paralyzing stroke, she slipped into a persistent vegetative state, unable to comprehend anything and kept alive by artificial means. Ms. C’s family remembered her words. She had always said she wanted to “die with dignity” and “did not want to be a burden” on anyone. So, Ms. C’s family asked her physician to stop artificial feeding and fluids (food and water through a tube) and allow her to die according to her wishes. When asked if Ms. C had a Health Care Proxy or a Living Will that made her health care wishes known, Ms. C’s family discovered that she had neither. The hospital refused to stop the artificial food and fluids.

Ms. C’s family went to court to order the hospital to stop feeding Ms. C. However, New York law requires clear and convincing proof of a person’s wishes regarding end-of-life care. That is, it must be shown that a person who has become incompetent had previously-given clearly-defined instructions that he or she wanted life-sustaining measures to be terminated. In Ms. C’s case, based solely on her past statements about being a burden on her children, the court could not direct Ms. C’s physician to withdraw artificial food and fluids. Such remarks, the court concluded, were too unspecific and casual and were not “clear and convincing proof” that Ms. C would have wished life-sustaining procedures to be withdrawn in her medical situation.

A situation like Ms. C’s (see box above) can be prevented by planning your end-of-life care in advance. Preparing a few simple legal forms - a Health Care Proxy, for example - can help to ensure that your health care wishes are followed and your health care decisions stay in the hands of people you trust.


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