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AN OVERVIEW OF ADVANCE DIRECTIVES

Throughout most of our adult lives, we remain in full control of all matters concerning our personal healthcare.  We decide whether or not to seek medical care or advice concerning any condition or problem we experience.  We select the doctor or medical facility to provide the medical care we may require. We determine if we wish to accept or reject the recommended treatment planned for our condition.  We are in full control.  What happens, though, if we are unconscious or lack the mental capacity to make decisions of this type?  What happens then?

In the State of Indiana, there are several arrangements which can be utilized to make decisions of this type in advance, or to designate the person to make such decisions for us in the future if we are unable to make them ourselves. They are frequently referred to as “advance directives.”   They include, but may not be limited to:

  1. Durable General Powers of Attorney;
  2. Appointment of a Health Care Representative; 
  3. Living Will or Life-prolonging Procedures Declarations;
  4. Organ and Tissue Donation; and
  5. Out-of-Hospital/Do Not Resuscitate Declarations and Orders.

A brief description of each of these advance directives follows:

Durable General Power of Attorney.   This is a document by which you can appoint an agent or attorney-in-fact to whom you grant power and authority over your financial affairs, health care matters, or both, under Indiana’s Power of Attorney Act. Granting authority as to health care matters includes:

  • Making choices concerning the doctors and health care facilities where you will be treated or cared for;
  • Signing health care contracts for you;
  • Admitting or releasing you from a hospital or other medical facility; and
  • Reviewing and obtaining copies of your medical records.

Health Care Representative Appointment.  This is a document whereby you can appoint a representative to make decisions for you concerning the health care which you will receive if your doctor feels such a decision needs to be made and you are not capable of making the decision yourself. The Indiana statute authorizing the appointment of a health care representative designates the person(s) who will serve as your health care representative by default if you fail to designate such a health care representative yourself.  The person designated in the statute to serve as your health care representative may or may not be the person you would have chosen yourself to serve in that capacity.  

Living Will.  Perhaps the best known of Indiana’s advance directives is the Living Will Declaration, the document whereby you give directions to your family, your doctor and other medical personnel concerning the medical care you wish to receive at the end of your life.  A Living Will Declaration becomes effective only when your doctor has determined and certified that you have a terminal condition from which death will occur in a short period of time.  A Living Will Declaration directs generally that you be kept comfortable, but that life-prolonging procedures be withheld or withdrawn.   In a Living Will Declaration, you can also give specific instructions as to whether or not you would want to receive artificial nutrition and hydration (i.e. tube feeding) under the circumstances when the Living Will Declaration is operative.

Life-Prolonging Procedures Declaration.  This document is the opposite of a Living Will Declaration and directs that if you have a terminal condition, your doctor should use all available means to extend your life for as long as possible.

Out-of-Hospital/Do Not Resuscitate Orders.  Any competent adult who does not wish to be resuscitated outside a hospital or medical facility can execute a declaration to that effect.  A “Do Not Resuscitate” order, however, can only be issued by the individual’s attending physician, and only after the attending physician has determined the person has (i) a terminal condition, and (ii) in the event of cardiac or pulmonary failure, resuscitation would be unsuccessful.

It is important to remember that any of the advance directives noted above, once executed, should be reviewed periodically to make sure it expresses your current wishes and desires.  Feelings about the kind and extent of medical care we might want to receive change over time, as can the persons we would want to be making health care arrangements and health care decisions for us.