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Be Prepared For Medical Emergencies

By Stuart A. Arnheim

Be Prepared is the Boy Scout Motto You are eighteen years or older, and you are driving to meet your significant other at the Ocean City, Maryland to spend a romantic weekend. Just as your getting off the Pennsylvania Turnpike the car in front of yours slams on its breaks to avoid hitting a deer. You try to stop but cannot avoid hitting the car in front. You suffer a crushed skull due to the failure of your air bags to inflate. The paramedics find you in a comatose condition from which the odds are you will never recover. The hospital staff calls the doctor's number they find in your wallet and ask whether you have a Health Care Directive in your medical file to determine the amount of medical service you want. Your doctor responds that you do not have a Health Care Directive on file. Depending on your ages your doctor states that "your siblings or children are minors, in which case none of them are legally permitted to serve as a Health Care Proxy. Or, she says you have three adult children living on the West Coast. To the best of her knowledge, no one has been designated in writing as a Health Care Proxy". Under these circumstances, the decision for the doctors to connect you to respirators is strictly theirs and given malpractice lawsuit options, they decide to keep you alive in your comatose state, to use stomach tubes to feed you, and to connect you to an IV hydration. Had you been prepared for this type of emergency you would have (1) written a Health Care Directive that states whether or not you want your life prolonged when there is little or no hope for a meaningful return to a quality and dignified life style. And (2) you would have named one or more family members or friends as a Health Care Proxy to instruct the doctors as to what you want done or do not want done. Why? Because Congress passed The Health Insurance Portability and Accountability ACT (HIPAA) of 1996 prohibiting physicians, nurses, hospital staff, or any other medical or mental facility from discussing or giving information on any patient to anyone: including a spouse, child, parent, sibling, cousin, or partner in an alternative lifestyle. [1] This law can be a particular problem if your family members live in distant cities, or if you have caregivers, or if you have suffered a critical injury, terminal illness, or degenerative disease from which there is very little chance of you recovering to an acceptable and dignified level. Anyone you want to know about your physical condition or mental state should be as named as a Health Care Proxy. In this article, and in some jurisdictions, a Health Care Proxy is the same thing as a Durable Power of Attorney for Health Care. You should have prior discussions with each of your Health Care Proxies as to circumstances under which you believe in prolonging life. Nevertheless, without such health information being included in a Health Care Directive (in some jurisdictions called a Living Will) you and your Health Care Proxy have no control over what procedures the hospital takes to prolong life. A person who has agreed to be your Health Care Proxy will not be able to refuse or consent to those health care decisions you want supported unless you discussed your feelings on prolonging life without quality or dignity. Written instructions on whether or not you want artificial nutrition (feeding tubes), and hydration (water provided by a feeding tube or intravenous line), your position on resuscitation, drugs such as antibiotics, or painkillers is essential if you want to deny them being used. You should prepare a list of all the Health Care Proxies you have named, their addresses, telephone numbers, e-mail, or mobile phones, the date of appointment, their religion, and relationship to you and whether or not they have any authority to act as your Health Care Proxy. You should consider appointing successor Health Care Proxies so that there is always someone authorized and available to act on your behalf. If you divorce, your former spouse is automatically legally unable to serve as your Health Care Proxy unless you reappoint him/her. You should provide for all Health Care Proxy holders and all successor Health Care Proxy holders a document to evidence their willingness to implement your Health Directive by signing a document accepting the Health Care Proxy. You should have successor proxy holders in the event a vacation, illness, accident, work, or change in ability to contact, or change in ethical, emotional, or religious belief prevents a previously designated Health Care Proxy holder from carrying out your instructions. The problem is to draft language that provides decision-making authorization to one person who happens to be available at the time a decision is required. An attorney can probably do this best. Give a copy of the Health Care Proxy to each person you select to fill that position, and to your physician, your dentist, your attorney, and any family members or friends who you appoint as a Health Care Proxy. You should keep a copy in your wallet. Let people know where you keep your original copies. Do not file them in safe deposit boxes or locked drawers that are inaccessible in an emergency. You may appoint your doctor but he/she cannot be your Health Care Proxy and your attending physician at the same time.[2] In any event, discuss with your doctor how he/ she feels about your Health Care Directive or Health Care Proxy. If the doctor is unwilling to support your wishes, or if the hospital is unwilling to do so, ask them to help find a physician or hospital that will do so. They are legally obligated to provide such help. If you are living in a nursing home, mental institution, or hospital, there are special restrictions about naming someone on the staff as your Health Care Proxy. Ask for an explanation of these rules. Your Health Care Proxy does not start until a physician determines that you are unable to make "health care decisions". It expires if you send a letter rejecting it, or if your appointment is withdrawn by the party who originally requested you to serve as a Health Care Proxy, or if the person who selected you regains his/her ability to make health care decisions as confirmed by a physician. US Legal Forms defines "health care decisionsÓ as follows:[3] Informed consent, refusal of consent, or withdrawal of consent to any and all health care, including life-prolonging procedures. The decision to apply for private, public, government or veterans' benefits to defray the cost of health care The right to access of all records of the principal reasonably necessary for a health care surrogate to make decisions involving health care and to apply for benefits. The decision to make an anatomical gift. Informed consent is consent voluntarily given by a person after a sufficient information and disclosure of the subject matter to enable that person to have a general understanding of the treatment or procedure and the medically acceptable alternatives, including the substantial risks and hazards inherent in the proposed treatment or procedures, and to make a knowing health care decision without coercion or undue influence. Residents of Florida, Oklahoma, Wyoming, New York, Connecticut, Massachusetts, and Michigan can find information on what your states require by contacting the web site: The letters FL/FL represent the state of Florida. The initials of the other states may be used in place of FL/FL. The Health Care Proxy and a Health Care Directive generally must be witnessed by two adults, neither of whom are the appointed Health Care Proxy. According to the New York Department of Health, you do not need a lawyer or a notary, just two adult witnesses.[4] However, it is always a good idea to have legal papers this important drafted or reviewed by your legal counsel. Your Health Care Proxy will begin only when your doctor decides that you are not able to make your own health care decisions, or while you are under anesthesia. If you are able to make decisions then the Health Care Proxy is merely on standby status. Always take a copy of your Health Care Proxy and Health Care Directive to the hospital if you are going through inpatient services or outpatient therapy, surgery, or a procedure. The hospital is required to place your Health Care Directive in your medical file. Your Health Care Proxy is not liable for health care decisions made in good faith on your behalf and in accordance with your directions. In addition, the Health Care Proxy cannot be held liable for the costs of your care because he/she is your Health Care Proxy. Should your health improve to the point at which you are able to make your own health care decisions, the Health Care Proxy becomes dormant. While taking steps to prepare for future health problems, which may never occur, consider joining an organization such as Medic AAlert.[5 They compress a lot of important health information onto a "dogttag" like necklace or bracelet. If you are involved in an accident the staff at the hospital to which you are transported has the ability to call a central source open 24/7 to obtain a list of the medicines you take, are allergic to, and any other medical information such as NO MRI which is critical to people with DBS-STN. You can supply Medic Alert type medical records companies to include the names of your Health Care Proxies and alternatives. The End-of-Life Partnership of Western Pennsylvania, a 501-C-3 non-profit corporation has a web site that can be contacted at (the site was down at the time of posting this article). They have a pamphlet "Western Pennsylvanians Talk About Death and Dying on Their Own Terms" printed March 2002. In addition, the Allegheny County Bar Association and the Allegheny County Medical Society jointly issued a free booklet entitled "LivingWill and Healthcare Power of Attorney." It includes a ready to complete advance directive form. You should also include any instructions for donating organs and tissues. Such instructions should be in writing. If it is not in writing, some state laws provide a list of individuals authorized to consent to organ and/or tissue donation on behalf of your estate. One corpse can provide over 200 tissues and organs that may save another person's life or functionality. You should stipulate that under the Health Care Directive and the Health Care Proxy, all of your assets should be kept separate from any Health Care Proxy assets. You need to think about whether you want to give the Health Care Proxy access to your financial records. This includes the ability to withdraw from bank accounts or to sell stocks, bonds, or withdraw from your IRA to pay bills. Who ever you use as your financial power of attorney is going to have to work with the Health Care Proxy. Do you want a bank trust officer or your attorney at law or some other party to handle the financial issues? I am not a lawyer. I am a person with Parkinson's disease writing about this important subject. My two adult daughters and wife are very concerned that I drafted my own Health Care Directive and Health Care Proxy.

If you have questions on any of these procedures, or need help writing them, call your lawyer. Be prepared today. Tomorrow could be too late. [1] Bottom Line Magazine, April 2004, Volume 12, Number 4 issue, page 4 and Littman & Kroogs, LLP NYC [2] About the Health Care Proxy Form, Info for Consumers, NYSOD, Revised January 2003 [3] Florida State Law Summary, Designation of Health Care Surrogate, [4] [5] Medic Alert 1-800-432-5378 or

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