Advance-care directives
ensure wishes are followed

By MARK A.WOLBER

An individual with mental capacity has the right to accept or reject medical treatment, including all life-sustaining measures.

However, under New York law, no one has the right to make medical decisions for you, including your spouse and family members, unless you have advance-care directives to apply when you lack the capacity to make your own medical decisions.

These advance-care directives can take the form of a health-care proxy, living will or do-not-resuscitate order.

Health care proxy

A health care proxy is your written appointment of a health-care agent, to make medical decisions for you if you lack the capacity to make those decisions.
Health-care providers are required, by law, to comply with decisions made by a validly appointed health-care agent.

You may appoint a health-care agent if you have the mental capacity and are at least 18 years old. You can revoke or modify your proxy at anytime.

The agent may be anyone 18 or older, but need not be a family member. You should discuss your wishes with your health-care agent so that your proxy knows your wishes and can express those wishes if the need arises.

If you have not appointed a health-care agent, then you may be subjected to undesired medical procedures, even if your family members request the termination of such treatment and you have orally made your wishes known to them. The only way to ensure that your wishes are followed is to appoint a health-care agent.

Once you have signed the proxy you should:
ä Give a copy to your physicians

ä Give a copy to your agent

ä Carry a copy with you

ä Place a copy in the freezer compartment or your refrigerator (this is where paramedics are trained to look for advance directives if you are unresponsive and there is no one who can produce the proxy).

Power of attorney

A power of attorney is used to designate another to act on your behalf in various legal matters. However, health-care decisions cannot be made with a power of attorney.

A durable power of attorney is similar, except that it continues to be effective even if you become mentally incompetent. Health-care decisions cannot be made with a durable power of attorney. While a durable power of attorney is recommended, especially for the elderly, it is separate from a health-care proxy and is not a substitute for a health-care proxy.

If you have not signed a durable power of attorney and you become mentally incompetent, having someone designated to act for you requires a court proceeding, which may be costly and time consuming.
This can be confusing, as some states use the term “health-care power of attorney” for what New York state calls a health-care proxy.

Living will
A living will is your statement of your wishes regarding your medical care if you lose the ability to articulate those decisions. However, you cannot use a living will to designate an agent to make those decisions.

One disadvantage of a living will is that if you have not anticipated a particular condition and, thus, have given no directions, the document will be ineffective.

Another disadvantage is that you will be making a decision without knowing all the facts, including your prognosis, at the time that a decision must be made.

Do not resuscitate order (DNR)

This is your wish not to have cardiopulmonary resuscitation (CPR) if your heartbeat or breathing stops.
Such an order should be thoroughly discussed with your physician. There are numerous instances where persons whose hearts have stopped have received CPR and continue living for many years without any residual effects.

DNRs may be most appropriate for those who are terminally ill and do not wish to prolong their lives.

Mark A. Wolber is an attorney in Utica.