Info - Living Will +
Note: This is general legal information intended only to inform the reader. If you need legal advice, you should consult an attorney. See entire Disclaimer.
1. Your Name: identifies you, the person creating the Living Will and the Durable Power of Attorney for Health Care (these two documents will have the names used in your state, or they will be combined into a single document if that is a requirement in your state). Enter your name here starting with the first name. The current official name, as it appears on the driver license for example, should be listed here. If other names were used on some of your medical records, they should also be listed. This would make medical personnel's job much easier. Examples: Paul Cooper; aka, Paul Blake; aka, Paul Cooper-Blake.
2. Your Gender is generally needed for the purpose of using the proper pronoun in the document, and more importantly, for addressing potential gender specific concerns required by the law of your state. If you are a female, indicate if you are pregnant now(1), or, whether or not it is physically possible to become pregnant in the future (2). If the answer to one of these two questions is yes, select "Yes."
3. Your State not only further identifies you, but it is required as the law differs in each state. Your Living Will document will be in compliance with the law of the state indicated here. In general, your state is the state where your main legal residence is; that is the state where you live or you have most contacts with by voting there, owning property there, having bank accounts there, etc.
4. Doctor Information (Name, Address, Phone #). This information is optional, but if you have a primary care physician you trust and you would like him/her to oversee your medical care, you can enter his/her name and contact information here. Your doctor will consult with your agent, who you'll name lower at #5, regarding your treatment options when you can no longer decide for yourself. It is generally a good idea to talk with your doctor about this document and your health care wishes. As always, if you have one, naming an alternate (2nd choice) is advisable here as well, as there is always the possibility that the 1st choice might not be able or willing to serve.
5. The Health Care Agent is the person you authorize to (1)supervise the fulfillment of your final health care wishes as you describe them in this document or you communicate to him/her in other ways, and (2), make health care decisions for you which you do not cover in this document or in other communications you have with him/her. Your agent's authorization starts only when you become unable to make or to express your health care decisions or wishes. Naming a health care agent is optional, but for obvious reasons recommended if you have a person in mind you trust.
This is one of the most important decision you have to make for the purpose of creating these health care documents. Most people would name a spouse, a child, or a relative, but you can choose any competent adult you trust and is willing to serve. In order to avoid unnecessary conflicts, it may be wise to name as health care agent the same person you named as attorney-in-fact of your durable power of attorney for finances (if you made or will make one), as the responsibilities of the two are intertwined. When choosing a health care agent, the following are some of the factors which should be considered: trustworthiness, relationship with you, his/her agreement with your final health care wishes, his/her willingness to serve, his/her skills, and his/her residence.
You can name more than one person to serve in the same time, but it is usually a good idea to name only one in order to avoid unnecessary conflicts and delays in resolving your health care matters. By contrast, as always, naming an alternate (2nd choice), if you have one, is advisable here as well, as there is always the possibility that the 1st choice might not be able or willing to serve. For both, first and second choice, list the correct name, relationship to you, complete address, and phone number. If you are not sure, ask the person you want to designate. Example: John Smith, my son, 234 Norman St., Apt. 100, Irvine, CA, 92555, (949) 555-6666. Listing the name and the contact information of your agent would enable your health care providers to promptly contact your agent when the need arises. Your relationship with the agent would give further assurances to the medical professionals that you appointed a qualified person, with whom they would be comfortable discussing your treatment options.
6. Authorization Limits. Here, if you named an agent above, you indicate what powers you give that person. The authority, can be broader or narrower, depending on your situation and your intent or wishes. Once named, the health care agent has some basic inherent powers, but important powers can only be given here expressly by you.
Here, is a list of important authorities with explanations attached. You can choose to give your health care agent authority over:
a. life support; with this authority, your agent may direct medical professionals to withhold or withdraw life support in situations when you would not want it. Even if you grant this broad authority here, your agent is bound by your specific wishes you express later in this questionnaire.
b. food and water; even though this may be considered a life support situation, it is listed separately, to ensure that your wishes are clearly expressed with respect to food and water; this is very important in light of the history of medical, legal, and political controversies, this issue has created. With this authority your agent may direct health care professionals to withhold or withdraw food and water when you would not want them. Even if you grant this broad authority here, your agent is bound by your specific wishes you express later in this questionnaire.
c. organ donation; with this authority, your health care agent can make decisions regarding the donation of your organs, tissue, or body parts, after your death. The agent would be authorized to carry out your wishes: to donate or to refuse to donate. Even if you grant this broad authority here, your agent is bound by your specific wishes you express later in this questionnaire. If you do not express your wishes with regard to donation of organs, tissue or body parts using this document or other means, normally your next of kin will make this decisions after your death.
d. consent to autopsy; here, you may consent to autopsy, or let your agent make that decision for you after your death. (If the death occurs under suspicious circumstances, state law may authorize a medical examiner to perform an autopsy). An autopsy may be beneficial to your family members, as they might want to know more about your cause of death, and therefore, to what health risks they may be also exposed. It may also benefit the community if you die of a relatively unknown disease.
e. burial or cremation; if you expressed your wishes on this subject in another document, choose this option, and describe the document; indicate also where it can be found. Your wishes would be carried out by your agent. Otherwise, here you can give authorization to your agent to make this decision for you when the time comes ("Yes"). If you choose "No," your family members will have to make this decision.
7. Guardian Choice. Here, you can indicate whether or not you want you health care agent named earlier to act also as your personal guardian. A personal guardian, sometimes called conservator, is a person named by the court to make personal decisions for you like where to live, what activities to have daily, etc. A court gets involved, only when you can no longer make these decisions yourself, and a question is raised as to who should serve. In general, the court will seriously consider your choice here. By choosing to nominate your health care agent also as personal guardian, you clarify that if the need arises, your wish is that your health care agent make health as well as personal care decisions for you.
8. Specific Health Care Wishes. This is very important. You can choose to let your health care agent make all the specific health care decision for you. But here, you have a chance to express your specific health care or treatment wishes, and by doing so, you keep more control over your final health care options. Your agent would have to work with your doctors to fulfill your specific wishes.
A. Terminal Condition. In general terms, terminal condition means an illness or injury from which doctors believe (1)there is no chance of recovery, and (2), due to that illness or injury, death will likely happen soon. The definition may be different in each state. Your document will include the definition used in your state. Life support generally refers to procedures that only cause the death of a terminally ill person to be postponed.
Food and Water refers to artificially administered food and water. This treatment option is presented separately, because, as mentioned earlier, this is a very controversial issue; the clearer you express your wishes here, the less likely is that they will be later disputed.
Make your selections here carefully.
B. Permanent Unconsciousness; this, in general means that (1)the person is in an irreversible state in which she is unaware of herself or her surroundings, and (2), she cannot meaningfully respond to external stimuli. E.g., persistent vegetative state, permanent coma.
Again, make your selections carefully.
9. Additional Wishes. This optional, but you are given the opportunity to add to your list of health care wishes.
Location of care. Name the place where you would want to be in your final days. E.g., "at home," "at XYZ health care facility."
Comfort care. List here the things that would make you comfortable at the end of your life. E.g., classic music.
Pain Relief Exceptions. The default option in your Living Will is to state that you wish to receive the necessary pain medication to reduce your pain, and make you comfortable. You may list here medication you do not want to be used, if any, or situations in which you do not want to be given pain medication.
Personal or Religious Values or views with regard to health care or life and death, can be stated here. They may help your care givers choose from the available treatment options.
Other Wishes. Write here any additional wishes you may have, or statements you may want to make.
10. Pregnancy (for women). If you are a women, and you are pregnant, or may become pregnant, you may want to express your wish clearly here, as to whether or not, you want your health care wishes enforced while you are pregnant. This is important because some states or health care facilities may favor keeping the fetus alive over your wishes. Stating clearly what you want, may increase your chances of having your wishes enforced.
11. Specific Wishes Regarding Organ Donation. If earlier at # 6 you have authorized your agent to make decisions regarding organ, tissue, and body parts donations, here you can be more specific about how you want your wishes to be carried out. If you did not authorize your agent, giving specific instructions here is equally important, as it would help your family members make these choices when the time comes.
Use the first choice if you have already expressed you specific wishes on this subject in a different document, or using different arrangements. Describe the respective document or arrangement here.
Use the second option, to leave specific instructions in this document. You can choose to donate all of your organs, tissue, and body part, or only the ones you list here. Additionally, you can indicate that what you donate can be used for any lawful purpose or only for the purposes you choose here.
Of course, you may not want to donate any of your organs, tissue, or body parts. You can indicate that wish here (3rd option).
If you do not wish to make any statements in this regard in your document (4th option), your agent - if you authorized him, or your family members, will make these decisions when the time comes.
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