A Primer On Health Care Directives.

In 1990, 26-year-old Terri Schiavo lay in an irreversible vegetative state in a Florida hospital. During the following 15 years her family members would engage in a series of legal challenges and personal battles over her medical care. But only one person really understood what would be best for Terri Schiavo. Unfortunately, that person--Terri Schiavo--was unable to communicate. And there were no instructions to guide her medical providers on what to do.

Since that time, legislatures in almost every state have provided a more streamlined process for individuals to create a legal document that specifies what actions should be taken for their health care when they are no longer able to make those decisions themselves due to illness or incapacity.

Prior to August 1, 1998, Minnesota law provided for several types of directives, including living wills, durable health care powers of attorney, and mental health declarations. Forms created before August 1, 1998, are still valid if they followed the laws in effect when written.

The law changed in 1998 to allow people to use one document for all their health care instructions.

A Health Care Directive, sometimes referred to as an "advance directive," is a legal document that has two components: 1) it provides instructions concerning your health care in the event you are unable to make those decisions yourself, and 2) it names one or more persons to act as "fiduciaries" or agents to access your medical records and make health care decisions on your behalf--what is known as a Durable Power of Attorney for Health Care (DPAHC). You must be at least 18 years of age to make a Health Care Directive.

A Health Care Directive is important in that it gives guidance to your physician, family and friends in the event you are unable to communicate due to physical or mental incapacity. A Health Care Directive sets forth your health care goals, concerns and fears and helps to ensure that your wishes are followed, even if those wishes are contrary to the interests and beliefs of others. You can state what you want as well as what you don't want. You can also state limits of the powers you want to give to your agent.

To be valid, a Health Care Directive must:

✦ Contain your name;

✦ Be in writing and dated;

✦ Be signed by you (or someone authorized to sign for you) while you are still able to understand and communicate your health care wishes;

✦ Have your signature verified by a notary public OR two witnesses; and

✦ Include the appointment of an agent to make health care decisions and/or instructions about the health care choices you wish to make.

Before preparing your Health Care Directive, you may wish to speak with your physician or other health care providers.

Your Health Care Directive may include many items, including:

✦ The name of the person you designate as your agent to make health care decisions for you. You may name alternate agents in case the first agent is unavailable, and you can even assign joint agents;

✦ Your goals, values, and preferences regarding health care;

✦ The types of medical treatment you want or do not want, including instructions about artificial nutrition and hydration;

✦ How you want your agent(s) to make decisions;

✦ Directions to joint agents regarding the process or standards by which they are to reach a health care decision;

✦ Where you want to receive care;

✦ Your preferences regarding mental health treatment, including those that are intrusive;

✦ Instructions if you are pregnant;

✦Your wishes regarding the donation of organs, tissues, or other body parts; and

✦ Your funeral arrangements and interment of your remains.

There are some limits:

✦ Your agent must be at least 18 years of age.

✦ Your agent cannot be your health care provider, unless the health care provider is a family member or you give reasons for naming of the agent in your Health Care Directive.

✦ You cannot request health care treatment that is outside of reasonable medical practice.

✦You cannot request assisted suicide.

Your Health Care Directive becomes effective when it meets all the requirements described above and your health care provider determines that you are no longer able to make health care decisions for yourself. Your health care provider generally will follow your Health Care Directive, or any instructions from your agent, as long as the health care follows reasonable medical practice. However, you or your agent cannot request treatment that will not help you or which the provider cannot provide. If the provider cannot follow your agent's directions about life-sustaining treatment, the provider must inform the agent. The provider must also document the notice in your medical record. The provider must allow the agent to arrange to transfer you to another provider who will follow the agent's directions.

Your Health Care Directive is effective until you change or cancel it.

You may cancel your Health Care Directive by doing any of the following:

✦ Making a written statement stating that you want to cancel it.

✦ Destroying it.

✦ Telling at least two people that you want to cancel it.

✦ Writing a new Health Care Directive.

To get started in making your Health Care Directive, you can access downloadable forms from a number of sources, including the Minnesota Attorney General's Office. These forms are intended to allow you to fill out and sign the Health Care Directive by yourself. However, it is a very good idea to consult a qualified attorney to discuss any questions or concerns you may have. An attorney can help you craft a Health Care Directive that more closely meets your needs and expectations.