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Do I need to be healthy in order to fill out an advance directive?In the US, you only have to be competent to make out Advanced directives.. Competent is a legal term indicating that you are capable of making your own decisions. You can certainly be healthy to do so, and all people should consider doing so.Advanced directives are interesting because they only gain legal force when you are not competent. Whenever you regain your ability to make decisions, they have no more power any more, unless you again lose your ability to make decisions.Advanced directives can take on different forms. Most states have so called “living wills”. These are a special kind of advanced directive spelling out specific preferences, usually about specific life prolonging interventions, under very specific circumstances. These were some the first advanced medical directives to gain legal standing and popular attention. A lot of people still use Living Will and Advanced Directives, as interchangeable terms. However, Living Wills are only one type of advanced directives, and are very limited in scope.Another common form of advanced directive is the Durable Medical Power of Attorney. These are much broader and useful documents. I have seldom seen Living Wills be useful in practice, but Durable Medical Powers of Attorney can make things easier for the patient, the doctors, and the family alike.What the Durable Medical Power of Attorney does is designate a person or persons to make medical decisions for you if you are unable to do so yourself. The document might include some specific instructions, or may not. The reason that they are so useful is two fold. The big thing is that they clear up to everyone who is in charge. In medicine, the patient is always in charge as long as he is capable of making and communicating decisions. When he can’t do that, who calls the shots? Well, some states spell that out in law, but that might not reflect the real dynamics of a family, and people will disagree, or not want the burden. This not only can make things hard for the doctors, who need permission or guidance to do their jobs, but can cause all sorts of family troubles, with children and siblings and others all having an opinion on what is best, and a lot of worries about making hard and terrible decisions. With the document, all that is cleared up ahead of time.But the biggest reason that Durable Medical Powers of Attorney are so helpful to all concern is that people talk about them. The patient chooses their own power of attorney according to preference. But before you list Aunt Ida as your Medical Power of Attorney, you will ask her. Then you will find out if Ida really wants that responsibility. And you will also need to talk to Ida about the kind of things you want or do not want. She will probably know you, and your values. Real life medical decisions are complicated and impossible to list completely in advance. But Ida will have a decent idea of what you do or don’t want, and will be able to represent your interests to the doctor. And all the other family members will know that she is who you wanted to make those decisions. It lifts so many burdens.It isn’t always easy to make medical decisions for another person, especially a person you love and care about. They can be life and death. People struggle with these sorts of ideas and might have strong opinions of their own. However, I always make it clear to those designated with Medical Power of Attorney that their job is not to figure out what is right in their own eyes. Their job is to tell me and other health care providers what the patient would want if he was able to talk to us. Their job is to keep the patient and his or her wishes front and center, as it should be.Like I said at the beginning, you can be healthy and make advanced directives. You never know what the next day will bring, so there isn’t a bad time. I think the Durable Medical Power of Attorney is a particularly good document for a young, healthy individual. It just designates someone you want to make decisions for you when you can’t, and it is only in effect when, and for as long as, you are unable to make your own decisions. As long as you keep up with your designee and still want them to be your power of attorney, you can “update” your wishes as often as you and your designee talk about such things. This is the way that people generally want to take care of their lives. The document just helps protect that desire in law from the hardship and heart ache of serious illness.
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