Do You Need an Advance Directive

by Karla McAlister

An Associated poll found that sixty –four percent of boomers - born between 1946 and 1964 – say they don’t have a health care proxy or living will. Many people stated they feel healthy and that death and dying is not on their minds. However, the reality of death is inevitable for all of us and none of us have a crystal ball to tell us when or how we will die. Thinking about aging and possible end of life situations allows you to decide what types of care should be provided to you or withheld if you are unable to make and communicate your own decisions at that future point in time.  Documenting your wishes concerning end of life care is a comforting gift for your family as they may need to make those decisions in the future for you and, if so, they will be a able to do so with the assurance they are carrying out your wishes. It lessens the anxiety, possible guilt and potential conflict between family members if you have told your family your wishes and your decisions are stated clearly in an Advance Directive for Healthcare. 

Oklahoma's Advance Directive for Healthcare allows you, if you are 18 years of age or older, to inform physicians and others of your wishes concerning life-sustaining treatment. This document evidences the patient’s exercise of their constitutional right of self-determination, allowing them to state when they believe enough medical intervention has occurred and they want to be allowed to die. If a patient authorizes or directs the withholding or withdrawal of life sustaining treatment such as resuscitation and use of respirators, it does not prevent healthcare professionals from providing the patient pain relief and other forms of comfort care (palliative care).  And, if the patient is no longer taking nutrition and hydration (eating and drinking), the Oklahoma law requires separate, explicit decisions concerning withholding or withdrawing artificial administration of food and water (nutrition and/or hydration provided intravenously). Each person can decide if they would want those treatments provided or withdrawn.  The Directive does not become operative unless you are diagnosed by two physicians to be in a terminal condition, a persistently unconscious condition, or an end-stage condition and, then, only if you are unable to make and communicate these decisions for yourself. The Advance Directive can also be used to donate one’s body or specified organs for transplantation, research or education.

The Advance Directive also allows you to appoint a Health Care Proxy to make decisions in your behalf. With the advances in healthcare it is possible to keep a dying person alive for days, weeks, months or even years with medical intervention. After you complete an Advance Directive, you may revoke it in whole or in part at any time and in any manner. A revocation is effective upon your communication to your attending physician or other care provider or a witness to the revocation. We advise clients to give copies of the Advance Directive to the persons they appoint as proxies and also to their doctors. The signed, original Advance Directive needs to be kept with your important documents but a copy should be handy to provide to a healthcare provider if you have a sudden health crisis. Your family should know where to quickly locate the document.  In order to assist our clients and their families in times of health emergencies, we recommend our clients inform us of the location of all their important legal documents, including their Advance Directive, so that we are prepared to assist their family and surrogate decision makers at those times. 

If you signed a Directive to Physicians or other Advance Directive for Healthcare under Oklahoma law prior to 2006, we recommend you consider executing the new Advance Directive because of additional options under the existing law. When we assist people with their estate planning we often prepare an Advance Directive for Healthcare and we also recommend a Healthcare Power of Attorney; the former deals with the end of life decisions as explained above and the latter is used to deal more generally with health and personal care decisions which might arise at any point in one’s life due to injury or illness and, in those situations, to delegate authority to an appointed agent to make those decisions for you if you do not have the capacity to do so for yourself.