Advance Medical Directives
An Advance Medical Directive (AMD) offers a means by which an individual (the Principal) can direct another individual (the Agent) to make health care decisions in the event the Principal’s physician determines that the Principal is not capable of making his or her own health care decisions.
The need for an AMD arises in four situations.
The first situation is also what is frequently called a “living will.” It arises if the Principal has been medically determined to be in a persistent vegetative state with no reasonable hope of recovery and with less than six months to live. These situations generally occur as the result of a progressive disease or in the case of severe traumatic injuries resulting, for example, from automobile accidents.
The AMD directs the Agent to sign the necessary paperwork directing the medical staff and the health care facility to withdraw all life support systems, including artificial nutrition and hydration, and authorizing a “Do Not Resuscitate” Order, also known as a “DNR” or “No Code” to be entered for the Principal. Pain killers will be continued to the extent necessary to alleviate pain, but which may result in addiction or inadvertent death.
The second type of situation in which an AMD is used involves the case in which the Principal’s death is not imminent, but he or she is not able to make health care decisions. These generally occur in cases where the Principal’s mental condition is declining due to dementia or Alzheimer’s disease.
The Agent’s role is to authorize necessary medical procedures, including the administration of prescription drugs, and generally to oversee the long term care and treatment of the Principal.
The third situation that a Principal may include is an authorization for the Agent to admit the Principal for psychiatric treatment for up to ten days even against the Principal’s will, if two doctors agree that such treatment is warranted.
It is not uncommon for individuals, especially seniors living alone, suddenly to appear confused, paranoid and disoriented and to refuse or resist all attempts to assist them. These situations may be the result of a stroke, the failure to take their medications or not to take them as prescribed, or simply the result of poor diet.
Admission to a treatment facility will determine the cause of the problem. If extended treatment is necessary, the Agent, other family members and the treatment team and make the necessary arrangements over the ten day stay. Otherwise, Principal can demand to be released, if the facility has not already done so.
The fourth use of an AMD is to express the Principal’s wishes with regard to organ donations at the time of his or her death. There is a growing need for organ donors and often medical practitioners will approach the family with a request for the donation of the Principal’s organs and tissue at the time of death.
A statement in the AMD either consenting to, or denying the harvesting of organs relieves survivors of the stress of having to make this decision at a difficult time.
It is important to remember that if an individual has elected to be an organ donor when he or she renewed a driver’s license, this election, not the AMD, will govern the actions of the medical staff at the time of death. If the “♥” symbol appears on the driver’s license, the individual has consented to be an organ donor, and a medical facility can confirm this at any time be contacting the DMV data bank.
The basic rules for AMDs are found in the Code of Virginia. They are an attempt to preserve the rights and privacy of a patient who is often not able to communicate his or her wishes and to provide the medical community with legal guidelines for handling end of life care, while at the same time honoring the patient’s faith and values.
If end of life issues raise any family, cultural, ethical or spiritual questions, one should consult his or her family and other advisors before signing an Advance Medical Directive.