A quandry awaits those of us who have chosen to live and heal ourselves outside the norm . Those choices we make may not be available to us if we slip into a delirium or become mentally feeble . Do you prefer to heal yourself with herbs and food ? Actually those choices are not readily available to cognitively impaired adults . Medicare and Medicaid , most or all health insurance companies do not pay for those alternatives . No long term care facilities offer wholistic treatments or diet . Your loved ones may be accused of elder abuse by withholding conventional treatment from you .
Here is a sample of an Advanced Directive . I have seen many of these , this one is very thorough . As you can see , it offers little in the way of communicating a desire for alternative medicine and therapies :
I, _____________________________________________________________, write this document as a directive regarding my medical care.
In the following sections, put the initials of your name in the blank spaces by the choices you want.
PART 1. My Durable Power of Attorney for Health Care
______ I appoint this person to make decisions about my medical care if there ever comes a time when I cannot make those decisions myself. I want the person I have appointed, my doctors, my family and others to be guided by the decisions I have made in the parts of the form that follow.
Name: ______________________________________________________________________________
Home telephone: ____________________________ Work telephone: _______________________
Address: ____________________________________________________________________________
If the person above cannot or will not make decisions for me, I appoint this person:
Name: ______________________________________________________________________________
Home telephone: ___________________________ Work telephone: ________________________
Address: ____________________________________________________________________________
______ I have not appointed anyone to make health care decisions for me in this or any other document.
PART 2. My Living Will
These are my wishes for my future medical care if there ever comes a time when I can't make these decisions for myself.
A. These are my wishes if I have a terminal condition
Life-sustaining treatments
_____ I do not want life-sustaining treatment (including CPR) started. If life-sustaining treatments are started, I want them stopped.
_____ I want the life-sustaining treatments that my doctors think are best for me.
_____ Other wishes _________________________________________________________________________
Artificial nutrition and hydration
_____ I do not want artificial nutrition and hydration started if they would be the main treatments keeping me alive. If artificial nutrition and hydration are started, I want them stopped.
_____ I want artificial nutrition and hydration even if they are the main treatments keeping me alive.
_____ Other wishes _________________________________________________________________________
Comfort care
_____ I want to be kept as comfortable and free of pain as possible, even if such care prolongs my dying or shortens my life.
_____ Other wishes _________________________________________________________________________
B. These are my wishes if I am ever in a persistent vegetative state
Life-sustaining treatments
_____ I do not want life-sustaining treatments (including CPR) started. If life-sustaining treatments are started, I want them stopped.
_____ I want the life-sustaining treatments that my doctors think are best for me.
_____ Other wishes _________________________________________________________________________
Artificial nutrition and hydration
_____ I do not want artificial nutrition and hydration started if they would be the main treatments keeping me alive. If artificial nutrition and hydration are started, I want them stopped.
_____ I want artificial nutrition and hydration even if they are the main treatments keeping me alive.
_____ Other wishes _________________________________________________________________________
Comfort care
_____ I want to be kept as comfortable and free of pain as possible, even if such care prolongs my dying or shortens my life.
_____ Other wishes _________________________________________________________________________
C. Other directions
You have the right to be involved in all decisions about your medical care, even those not dealing with terminal conditions or persistent vegetative states. If you have wishes not covered in other parts of this document, please indicate them below.
__________________________________________________________________________________________
__________________________________________________________________________________________
PART 3. Other Wishes
A. Organ donation
_____ I do not wish to
donate any of my organs or tissues.
_____ I want to
donate all of my organs and tissues.
_____ I only want to donate these organs and tissues: ___________________________________________
_____ Other wishes _________________________________________________________________________
B. Autopsy
_____ I do not want an autopsy.
_____ I agree to an autopsy if my doctors wish it.
_____ Other wishes _________________________________________________________________________
C. Other statements about your medical care
If you wish to say more about any of the choices you have made or if you have any other statements to make about your medical care, you may do so on a separate piece of paper. If you do so, put here the number of pages you are adding: _____________
PART 4. Signatures
You and two witnesses must sign this document before it will be legal.
A. Your signature
By my signature below, I show that I understand the purpose and the effect of this document.
Signature ________________________________________________________ Date ____________________
Address ___________________________________________________________________________________
B. Your witnesses' signatures
I believe the person who has signed this advance directive to be of sound mind, that he/she signed or acknowledged this advance directive in my presence and that he/she appears not to be acting under pressure, duress, fraud or undue influence. I am not related to the person making this advance directive by blood, marriage or adoption nor, to the best of my knowledge, am I named in his/her will. I am not the person appointed in this advance directive. I am not a health care provider or an employee of a health care provider who is now, or has been in the past, responsible for the care of the person making this advance directive.
Witness #1
Signature ________________________________________________________ Date ____________________
Address ___________________________________________________________________________________
Witness #2
Signature ________________________________________________________ Date ____________________
Address ___________________________________________________________________________________
Obviously , this standardized form will need a little tweaking to assure you continue recieving your prefered treatments while temporarily or permanently impaired .