A legal document that designates an individual to make medical decisions on the patient's behalf in the event the patient is unable to do so is called?

Answer 1

States recognize a Living Will and a Medical Power of Attorney.

A Living Will is a legal document, with required notorization, that allows a person to specify certain medical care options in the event the person cannot speak for herself. A Living Will is often thought of as an "End of Life" document because it covers such things as being intubated (having a breathing tube inserted down the throat), being placed on a ventilator, and fluid hydration. People can choose yes or no on these items, as well as specify their exact wishes about medical care if the patient can't speak for himself. A Living Will, though, can be 'vetoed' or over-ridden at the time by a family member. For example, a wife may want no ventilator or machine to keep her alive, but in the E.R., the husband demands that the doctors "do everything possible to save her".

Only a few States prevent a family member from over-riding a patient's wishes, and mostly the restictions concern organ donation. For example, in Pennsylvania, a Licensed Driver can indicate on the driver's license a Yes or No for organ donation. If the person chooses to donate and indicates this on a driver's license, the immediate family cannot veto the decision.

A Medical Power of Attorney gives a clear-cut Represenative, acting on the patient's behalf, to make all medical decisions if the patient is unable to speak for herself or if he is incompent to make his own decisions. For example, a 25-year old woman suffers an embolus (blood clot or air embolus) to the brain during labor and delivery. The woman's mother wants "to let my daughter go" but the husband, who has more legal standing due to being married, has the final say because he is the spouse. But, if the woman was divorced AND her mother had a valid, dated, and signed Medical Power of Attorney, the mother could decide whether her daughter should be intubated and kept on a ventilator or allowed to die.

Whomever the patient names as an Acting Representative on a Living Will or Medical Power of Attorney, the patient should fully discuss her wishes with her chosen representative. The patient should make it clear what he does--and does not--want done. The patient should have notorized several copies of each document: one to keep, one to give to the Representative, and one for the family doctor. Hospitals cannot act without a valid document.

The Representative should be a person who can be trusted to act the way the patient has requested. For example, a pregnant woman creates these documents "just in case" during her pregnancy, since labor has many life-threatening risks. This pregnant woman's beliefs are that if a child is meant to live, "God will provide" so the mom-to-be wants no heroic measures on behalf of her child or herself if one has complications. During pre-term labor, the woman begins to bleed heavily (hemmorrhage) and slips into a coma. They deliver a 3-pound newborn who has a very low pulse and respirations and will die within the hour from congenital abnormalities. But, instead of following the wishes the patient specified, the Acting Representative demands the doctors "do something" so the doctors try to save mother and newborn, causing both patients further pain and causing the family great distress. So, it's important that the patient signing these documents name someone who holds the same beliefs about life and death.

I used a maternity example, but conflicts arise in many patient situations, such as a man severely burned in a house fire, an elderly person having a heart attack, a young mother critically injured in a car crash, etc. Any age patient, in any circumstance, can face a situation in which someone else must make decisions on the patient's behalf.

Lastly, a conscious and competent patient can ask the doctor to create a document called DNR, or Do Not Rescusitate order. A DNR states that no heroic measures will be used to revive a patient--no CPR, no breathing tube, no ventilator, etc. As an example, a 55-yr old woman has lived in severe pain for 25 years due to a spinal injury from her waist to her coccyx. She has been mostly bedridden for 12 years. She is unable to walk more than 2 or 3 minutes, before she feels excruciating pain. Surgeons say that surgery will not restore her quality of life or stop the pain. She is on the strongest narcotics but still has pain. The patient has other medical conditions, none life-threatening, except the potential for airway problems due to Asthma. The woman is transported to a doctor each month, the only time she ever sees or smells the outside world; for 29 days straight at least, she's stuck in bed and in the house. She fears that if "something" happened, such as a fall, traffic accident in which she was a passenger, or if she had a heart attack, responders would try to revive her. She tells her doctor that based on the fact no doctor can fix her back and the pain, IF she had an acute and serious incident, she does not wish to have CPR measures. After thorough discussion, and making sure that depression is not clouding the patient's thinking, the doctor signs a DNR order. Note: The patient *can* change her mind; She *could* just rip up every copy of the order or "rescind" the document. But, with a signed DNR, her wishes would most likely be respected in any hospital or medical circumstance. With a DNR, it's important that the patient's family and any Acting Representative agree to uphold the DNR and to not interfere with the patient's wishes.