As medical technologies evolve and assume greater importance in health care, individuals are confronted by situations that involve difficult medical decisions. One important aspect of medical ethics is autonomy; allowing the patient to make informed decisions on their own. An advanced health care directive allows individuals to make decisions in advance if they are unable to speak for themselves. Informed consent requires that the patient is competent, understands the treatment options, and freely and voluntarily makes decisions regarding their medical treatment.
There are two federal laws which regulate the information given to patients regarding advanced care directives. The Patient Self-Determination Act, enacted into law by Congress in 1990, requires health care facilities inform their patients about their rights to decide how they want to live or die. The Uniform Health Care Decision Act (1993) promotes autonomous decision making by acknowledging individuals’ right to make health care decision in all circumstances. Any adult with mental capacity, can give instructions regarding their health care wishes to a health care provider or an agent of their choosing, which will remain in effect even if the adult loses the ability to communicate.
An advanced health care directive allows individuals to provide directions about the kind of medical care they do or do not want if they cannot communicate their wishes. It allows individuals to express their wishes about the use of life-sustaining treatment. It can also provide guidance for health care professionals, families, and substitute decision makers about their health wishes. It can also help provide legal protection for health care professionals who follow the instructions in the advanced health care directive.
In California, an advanced health care directive contains a section to name a health care proxy. A Durable Power of Attorney allows individuals to appoint someone (health care proxy, agent, or surrogate) to make health care decisions for them in the event they cannot make decisions for themselves.
Before filling out an advanced health care directive and selecting a health care agent, an individual should talk to their loved ones about their wishes. It is important to determine if the chosen health care agent would be comfortable with the health care wishes and the responsibility of carrying out those health care wishes.
An advanced health care directive is not a Prehospital Do Not Resuscitate (DNR) Form or a Physician’s Order for Life Sustaining Treatment (POLST). In case of a medical emergency, the DNR and POLST instruct emergency medical services providers as to an individual’s desire to forego cardiopulmonary resuscitation. A POLST form must be signed by a physician, or health care provider acting under a physician’s supervision.