ALABAMA A&M and AUBURN UNIVERSITIES
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THIS IS THE 6th IN A SERIES OF ARTICLES ON CONCERNS OF OLDER AMERICANS.
 
 

When One Cannot Make Decisions

AUBURN, OCT. 22---At some point in life, many people will need help managing their affairs or taking care of themselves. This can happen at any age and for many reasons. It's most likely to happen as you grow older, especially in the later years prior to death -- a time often characterized by increasing mental and physical decline.

Many individuals are disabled six months or longer before they die and may be unable to make decisions, says Dr. Jo Turner, Extension program specialist with the Alabama Cooperative Extension System.

A variety of legal documents are available to assist during these periods. Some provide temporary help, others offer more permanent assistance. Planning ahead enables you to make important decisions about how your personal and financial affairs will be handled if you are unable to manage.

There are numerous issues to consider including:

Older people and their families also need to consider a variety of choices such as long-term care, guardianship designation, power of attorney, and dispersal of property and household items, says Turner. Who will execute the last will and testament? Likewise, choices need to be made regarding measures to prolong life and the possibility of organ donation.

These are not pleasant issues, but when possible, the family needs to plan ahead. Discuss the issues with your family or persons you trust. Early discussion helps avoid decisions that are made in opposition to one's lifestyle and wishes, as well as decisions that are unacceptable to family members or significant others, Turner adds.

Legal documents, such as advance directives, enable you to exercise more control over your life. An advance directive is any written document signed in advance that gives explicit instruction regarding health care treatments. The document also can name someone to make such health care decisions for you if you are unable to speak for yourself. Advance directives usually take the form of a living will, a health care surrogate, or a durable (or springing) power of attorney.

A living will is a document that assists an individual in making his or her wishes known regarding life-prolonging treatment and "artificially provided nutrition and hydration." A living will is limited in applications, says Turner. It allows individuals to prepare in advance for the time they can no longer actively participate in making decisions about their health care. Typically, you and two other people must sign a living will; each must be at least 18 years old, of sound mind, and of no relation to you. They cannot be your doctor or employed by your doctor. They also cannot be employed by the health care facility where you are a patient or anyone responsible for paying your medical bills. Some states will accept a notarized living will.

Be sure to keep at least one copy in a safe, easily accessible place. You may wish to carry a copy with you when traveling, Turner says. Your wishes may not be honored in another state or country if they conflict with existing laws. The rule of the state where the treatment occurs controls, not the state where the living will was signed. Nevertheless, even if the living will is not honored in the treatment state, it is valuable evidence of the patient's wishes. It's also a good idea to provide a copy of your living will to your physician for your medical record and to relatives with whom you might live or visit.

A national study recommends that you or your health care surrogate (if you are incapacitated), discuss these issues with your attending doctor and note in your chart that you have a living will. This helps if an emergency occurs when your physician is not in the hospital. Otherwise measures might be taken that you have specified you don't want implemented. The study also showed that your living will should spell out which measures you don' t want taken.

A health care surrogate is a trusted person you name to make medical and health care decisions when you are unable to do so. The naming of the surrogate is very important. Surrogates must know your values and wishes intimately because they serve as your voice and advocate. In most states you can designate a health care surrogate in your living will.

There is a growing trend across the country to combine the living will and health care surrogate (which is also called a health care power of attorney) into a single, comprehensive document, says Turner. Such a document ensures that the majority of health care decisions for individuals lacking capacity, such as day-to-day care and placement and treatment options, are covered. The living will and health care surrogate should be executed at the same time, adds Turner. Generally speaking, a living will states your desires about life-prolonging treatment when you are considered terminal, while a health care surrogate makes medical treatment decisions for you if you are unable to make them for yourself.

Many people die each year while waiting to receive an organ transplant. While in recent years the supply of donated organs has increased, the number of transplants performed has also increased. Unfortunately, there is still a great shortage of donor organs.

Some individuals don't make known their wishes to donate their organs. Others may believe their religion doesn't allow for organ donations. Most religions today permit their followers to donate organs to allow another life to be spared. If you have questions on these issues, check with your religious leaders.

If you decide to donate your organs upon your death, you need to make your wishes known to others and note this on the back of your driver's license. Follow the proper procedure required by your state.

SOURCE: Dr. Jo Turner Extension Program Specialist with the Alabama Cooperative Extension System, (334) 844-3243.