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    Health Care Agents: Appointing One and Being One

    How do I appoint an agent?

    Every state now has some legal document to use when appointing a health care agent. Forms are available from a variety of sources that may include your local hospital, department of aging, or department of health.

    The documents are not difficult to complete, read the instructions carefully and follow the required witnessing procedure. You do not need a lawyer to complete the documents.

    Give copies of your completed document to your agent, alternate agent, physician, and anyone else who may be involved with your health care. Keep the original in a safe but accessible place. DO NOT KEEP YOUR ADVANCE DIRECTIVES IN A SAFE DEPOSIT BOX. Other people may need access to them. If you wish to change the person you have appointed, you must prepare a new document and be sure to notify and send copies of the new document to all involved. You can change or revoke your appointment at any time.

    Are there limits to the decisions my agent can make?

    Yes. Your health care agent cannot make financial decisions or manage your property unless you have provided that authority by other legal means. You can also limit your agent's authority by putting restrictions in your document. In a few states an agent can make decisions based only on what the patient has stated explicitly in the appointment document or living will. You should carefully check the National Hospice and Palliative Care Organization instructions for your state documents and the documents themselves to see what limits apply.

    What should I tell my agent? Your agent needs to know:

    • when and how aggressively you would want life-sustaining treatments applied, if you are terminally ill
    • the personal and spiritual values that guide your thinking about death and dying

    General statements such as "no heroic measures," "die with dignity," or "do everything" can mean very different things to different people and should not be used. To achieve a clearer understanding between you andyour agent you might discuss some concrete situations.

    The following are some examples:

    1. If you suffered a massive stroke or had a head injury from which you were unlikely to regain consciousness, how aggressively would you want to be treated? What if you were conscious but made a poor recovery and were unable to recognize people or to move your body?

    2. Would you want life-sustaining treatments that might prolong your life if you suffered from a progressive debilitating disease such as Alzheimer's disease, Parkinson's, or a similar disease and could no longer make decisions? If you want treatments, which ones? Everything? For how long? Indefinitely?

    3. If you were in any of these situations, would you want to receive artificial nutrition and fluids by tubes?

    4. If you were seriously ill and your heart stopped beating or you stopped breathing, would you want to go through resuscitation attempts or receive long-term mechanical ventilation?

    5. If your underlying disease were terminal and irreversible, would you want to receive antibiotics for pneumonia or other infections that might occur?

    6. Are there other medical conditions or circumstances when you would never want treatments such as ventilation, artificial nutrition and hydration, or antibiotics? Would you want them on a trial basis? Would you want them regardless of the outcome?

    7. If you were seriously ill, would you want aggressive pain management even if it shortened your life?

    8. Would you want special attention through receiving palliative care? Palliative care is a comprehensive approach to care that focuses on the physical, psychological and spiritual needs of the patient and the patient's family, maximizing comfort and quality of life.

    Although you cannot expect to cover every specific situation that might arise, discussions like this can help your agent understand how you think about the use of medical treatments at the end of life.

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