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    Health Care Reform:

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    Living Wills Make Life-or-Death Decisions Clearer

    Schiavo Case Puts Living Wills in Spotlight

    Can a durable power of attorney for health care be revoked?

    The patient can revoke a durable power of attorney for health care at any time and in any manner by simply tearing up the durable power of attorney for health care document, expressing orally to witnesses the desire to revoke the document, or in writing. Health care professionals who witness such revocations should document them in the medical record.

    How are the living will and durable power of attorney for health care implemented?

    Both documents, called advance directives, require that two doctors determine that the patient has lost the capacity to make health care decisions. A living will has the additional requirement that the patient must be suffering from a terminal condition or is in an irreversible coma.

    What are some other differences between the durable power of attorney for health care and the living will?

    The living will simply requires the withholding or withdrawal of life-prolonging treatment, whereas the durable power of attorney for health care names a specific person who is authorized to make decisions for the patient. Specific instructions may be given in the durable power of attorney for health care, but they are not required.

    How do health professionals know if a patient has an advance directive?

    Many hospitals and clinics will ask the patient or family upon admission about the existence of advance directives when they are admitted to the hospital. The existence of an advance directive is documented prominently in the medical chart. Also, health professionals should document the content of discussions about the patient's end-of-life desires or any expression of treatment preferences.

    Immunity

    Physicians and health care providers are immune from civil, criminal, and disciplinary action if they follow the advance directive statute in good faith and meet its provisions.

    Do Not Resuscitate (DNR) Orders

    Advance directives are not DNR orders. DNR orders are written by doctors to indicate that a patient should not be resuscitated. The order may be written to reflect a patient's or surrogate's expressed wishes about resuscitation, or because the patient will not benefit from resuscitation. For example, for someone with a living will or durable power of attorney for health care, CPR may be appropriate if they are suffering from an acute life-threatening condition. Patients with advance directives may want aggressive treatment for potentially reversible conditions.

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