Planning Ahead for your Care

Most people know the importance of having certain documents concerning their health care wishes, but still many never get around to actually completing the forms. Here's some information you need to know to make informed choices about your future care:

Health Care Proxy

In New York State, if you are unable to give directions concerning your health care, someone will be making those decisions for you. Those decisions may or may not be the ones you would have made for yourself. For that reason, NYS has a Health Care Proxy form that you may do in advance naming someone to be your health care decision-maker. A few important things to know:

•  You do not need a lawyer to fill out the form, although you may choose to have one

•  Your decision-maker (proxy) does not need to be a relative

•  The decisions concern health care, nothing else. It is only activated when you are unable to express your wishes

•  It is important to speak openly with you decision-maker about your general philosophy of living and dying- what medical technology you think may or may not be acceptable to you and under what circumstances. Leaving them guessing as to what you might want is risky and unfair to both you and them.

•  You may change your mind and your proxy when life situations change- simply retrieve all copies of the form you previously did and generate a new one

•  When completed, give copies to your doctor, any health care facility serving you, your lawyer and of course your proxy- make sure your proxy also knows where the original is kept

•  Two witnesses are required- they must be at least 18 years of age and not named as your proxy (or substitute proxy, if you name a second person).

•  In case of accident, it is wise to keep either a copy of your form with you or an "alert" card in your wallet so rescuers know how to reach your decision-maker.  

•  There are two very important limitations in this form:

•  Your proxy must "reasonably know your wishes for artificial nutrition and hydration" for them to make those decisions for you. You may indicate in writing your wishes or tell your proxy in advance. If you choose to tell your proxy, then you may wish to write on the form "My proxy has full authority to make ALL health care decisions, including artificial nutrition and hydration". That makes it clear that no one can dispute they have authority to speak for you in these matters.

•  If you wish no resuscitation (called CPR or cardiopulmonary resuscitation efforts- trying to restart heart and breathing when your body has died from progressive illness), you can put it on this form too, but it makes absolutely no difference if 9-1-1 is called. That's because 9-1-1 will only honor a DNR form (Do Not Resuscitate) signed by a physician, regardless of what your Health Care Proxy form says or what your Proxy instructs on your behalf.   See DNR below for more information on this topic.

•  The Health Care Proxy form is different than a living will. A living will is a written document trying to express your health care wishes if you are unable to speak for yourself, whereas a Health Care Proxy is a person expressing your health care wishes. In NYS, technically a living will is not recognized by statute like the Health Care Proxy form is, although in reality if a living will exists, the health care and legal system look to that as some evidence of your wishes. More importantly, t he Health Care Proxy form carries the backing of the legal system in NYS if disputes arise . You may have both forms if you wish.

•  For more information and to obtain a Health Care Proxy form, visit the New York State Department of Health's website at www.health. state.ny.us . Find site contents , click on forms and scroll down to Health Care Proxy form .

DNR (Do Not Resuscitate )

Since all of us at some time will have our hearts and breathing stop, generally from a progressive irreversible illness, you must think very carefully about medical technology "tubes and machines" . These procedures certainly have their place when your body needs support and time to recover. These same tubes and machines may be very unkind when you're dying from a progressive life-limiting illness. There are some important things you need to know:

•  A DNR form has to be signed by your doctor and seen by any health care professional involved with you to be honored. You doctor can give you good information about resuscitation pros and cons- when it may or may not be appropriate to do.

•  A DNR does not mean your airway wouldn't be cleared if you were choking. It simply means you don't wish attempts to restart a heart and breathing that has stopped due to death.

•  CPR (cardiopulmonary resuscitation) is touted very much in our society and definitely has its place. What most people don't know is its dismal effectiveness. The success rate for CPR performed outside a hospital is up to 3%. Success rate is defined as "living to be discharged home from the hospital". That is the success rate for all causes of collapse outside of hospitals- including heart attacks, electrocutions, drowning- basically many hearts that were okay before the collapse occurred. When progressive terminal illness is factored in, the success rate for CPR is essentially 0%. Hearts may be temporarily restarted, but the patients don't live to be discharged home.

•  If the underlying cause of your illness can't be fixed, then tubes and machines won't fix it either and they can actually cause you a whole lot of misery while you are dying. So you don't really know what we mean by medical "tubes and machines"? Then ask your doctor to show you the tubes and defibrillators and where they go and how they get inserted or used and what is done with them. There is no way you can make any kind of "informed choice" without seeing these things first hand. Then and only then can you know what your choices really are.

•  Far too many people get their medical care, especially at end-of-life, by default. That means everything gets done by default because they didn't plan their wishes in advance. Things will be done- unkind or not- in every attempt to prolong life, or more accurately, to prolong the dying- regardless of the burden to the body.

•  You need to think about what is and is not acceptable to you and under what circumstances. If you choose not to decide in advance, then you choose everything by default. It's all up to you.