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Getting Started with an Emergency, Critical and Advance Care Plan

Emergency, Critical and Advance Care Plans, and Advance Medical Directives

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Choosing a Healthcare Agent

A healthcare agent is a person you name in your emergency, critical and advance care plan to make medical treatment decisions for you if you ever become too sick or injured to make or communicate those decisions for yourself, or if a court ever declares you to be incompetent.

In most cases, your healthcare agent can be anyone that the law in your country or state considers to be an adult, but with these exceptions:

  • Your healthcare agent can't be your treating doctor or the doctor's staff (to prevent potential conflicts of interest, some countries and states say no medical treatment providers can be healthcare agents).
  • Your healthcare agent can't be the owner/operator or employees of the medical facility, nursing home, or hospice where you're being treated unless you're related by blood, marriage, or adoption.

Before you choose your healthcare agent, it's important to think about a couple of things:

  • Can this person be at the hospital to assess the situation firsthand and talk with your doctors?
  • Can this person handle the pressure of potentially very hard decisions during a time of great stress?

You should speak with anyone you're considering to be your healthcare agent to make sure that the person is comfortable with the responsibility. You also need to talk about your goals, preferences and priorities in cases of emergency or critical care, advanced illness, or end-of-life situations, and your thoughts about quality of life, so that the person you choose to be your healthcare agent will know how you'd like medical treatment decisions made on your behalf.

Once you're clear about who you would like to choose, MyDirectives makes it easy - just enter the name and contact information in the appropriate boxes. Or if you have previously entered this person in your list of personal contacts in your My Circle section, simply click on the person's name in the contact box that pops up.

Nothing says you have to choose a healthcare agent, but it's one of the most important things you can do to make sure doctors know your medical treatment goals, preferences and priorities if you can't make or communicate medical treatment decisions yourself, or if a court declares you to be incompetent.

Your healthcare agent makes medical treatment decisions for you if you're too sick or injured to make or communicate them yourself, or if a court ever declares you to be incompetent. Your healthcare agent also talks with your doctors and nurses and makes sure your choices are taken into consideration during the decision-making process. For this reason, it's important for you to discuss your ideas about quality of life with your healthcare agent. Let your healthcare agent know what you think makes life worth living and how much medical intervention is acceptable to you.

Before you choose your healthcare agent, it's a good idea to make sure the person agrees to take on the responsibility. If you change your mind later, MyDirectives lets you remove this person and update your emergency, critical and advance care plan with a new healthcare agent at any time. When you make a change, be sure to let everyone know, so there's no misunderstanding later.

Even if you have a healthcare agent, you still have complete control over all of your medical decisions unless, and until, doctors decide that you've lost your ability to make and communicate medical decisions for yourself, or a court declares you to be incompetent.

Your healthcare agent has no power over decisions that aren't related to healthcare, such as finances, work-related issues, funeral matters, or anything that might be covered in your will. Your healthcare agent also can't make decisions that go against your instructions or discussions. In most countries and states, your healthcare agent can't commit you to a mental health facility, or agree to psychosurgery, abortion, electroconvulsive therapy, or to anything against the law.

You can choose to limit your agent's authority to a specific period of time (days, weeks, or months) and to specific medical treatments. MyDirectives walks you through those options and lets you come back later to anything you don't understand or want to think about or discuss with your doctor.

No matter how carefully you plan for the future and how well you fill out your emergency, critical and advance care plan, you can't know ahead of time everything you might face. A healthcare agent makes decisions in times of crisis when you can't make or communicate your medical treatment goals, preferences and priorities, or when a court declares you to be incompetent, and your expressed wishes don't cover the situation.

People tend to think that choosing a healthcare agent is something only people who are elderly, frail, or chronically or terminally ill need to think about. But a serious accident can happen at any time no matter your age. If you're seriously injured or become so sick that you can't make and communicate your treatment goals, preferences and priorities, a healthcare agent speaks for you and makes medical treatment decisions on your behalf. The healthcare agent can make sure you get treatment that goes along with your values, beliefs, and wishes.

Choosing your healthcare agent is an important decision. Be sure to pick someone who knows you very well, is mature and level-headed, can handle stressful situations, and is easy to talk with. It should be someone you trust and who knows what's important to you. Choose someone who will argue for you with the doctors and nurses and make sure your wishes are carried out even if it means you will probably die. It's usually best if this person lives close to you and is available or willing to travel when needed. If you have more than one person in mind, talk with each person before you make up your mind. MyDirectives lets you choose one person to be your healthcare agent, and you can make the other one or two people your alternates in case your first choice is unavailable in an emergency.

It's important to talk to your healthcare agent about the medical treatments you would want or those you would not want to have, how aggressively you want to be treated, and under what circumstances. You should also discuss how and where you want to spend your last days and what you want done with your body if you pass on. These final details are all important. But it's just as important that your healthcare agent know what you consider an acceptable quality of life. When your healthcare agent knows these very personal details about you, then the healthcare agent can make medical treatment choices that are in tune with your wishes.

And don't choose someone because you feel like you have to; instead, choose someone who really knows you. Then communicate openly and often.

You can choose what kinds of medical treatment decisions your healthcare agent can make on your behalf if a situation arises where you can't decide or communicate for yourself. If you choose to have a healthcare agent, MyDirectives will ask you to pick what kinds of decisions you want your healthcare agent to be able to make on your behalf. Here's that list:

  • Interpret and communicate your wishes to your medical treatment providers and family
  • Choose doctors/hospitals
  • Arrange for your medical treatment in any country or state
  • Release your medical records
  • Stop/Start medical treatments
  • Agree to or decline tests/surgeries
  • Stop artificial nutrition and hydration
  • Put you in a nursing home
  • Consent to organ/tissue donation
  • Talk to your family
  • Talk to your spiritual advisor
  • Other (additional instructions you might want to give)

When you choose your healthcare agent, you can limit that person's authority to a specific period of time (days, weeks, or months). You might choose to do this if, for example, you know your healthcare agent will be moving in the future or will become unavailable for some reason. You can also limit the agent's authority to specific medical treatment decisions. MyDirectives walks you through these options.

Even if you have a healthcare agent, you still have complete control over all of your healthcare decisions unless, and until, doctors decide you can't make or communicate decisions for yourself, or a court declares you to be incompetent.

You should know that your healthcare agent has no power over decisions that aren't related to medical treatment, such as finances, work-related issues, funeral matters, and anything that might be covered in your will.

A healthcare agent becomes active if you lose the ability to understand the medical problem and the risks and benefits of medical treatment choices. Put another way, if you lose the ability to make and communicate choices that show you understand and appreciate the decisions being made and their possible consequences, or if a court declares that you are incompetent, then the healthcare agent steps in. You often hear the term "incapacitated."  In medical situations, if you become incapacitated, that means doctors have determined that you have become unfit or unable to make and communicate medical treatment decisions, and the healthcare agent will need to decide on your behalf.

If you are competent and can make and communicate medical treatment decisions, your current wishes take priority over both your healthcare agent's wishes and any written or recorded expressions of your medical treatment goals, preferences and priorities. Just because you've signed an emergency, critical and advance care plan or some other document like an advance medical directive doesn't mean you lose your right to decide on treatment when a situation arises - as long as you can express what you want and can understand the treatment choices, your current wishes are the most important. In most jurisdictions, if you can't make and communicate treatment wishes, or if a court declares you to be incompetent, your emergency, critical and advance care plan normally takes priority over your healthcare agent's wishes as long as your care plan is clear about your goals, preferences and priorities. In some jurisdictions, you can expressly state that you want your healthcare agent's decision to carry more weight. Since it's hard to anticipate every circumstance when you record your treatment preferences and priorities, it's important to talk with your healthcare agent about your wishes in advance. And don't forget, you can change your Universal Advance Digital Directive (uADD)™ at any time.

If your healthcare agent can't be reached when needed, it's important to have alternates. This is why MyDirectives asks you to name one or two alternates as potential healthcare agents - they are your backups. Having one or two alternates who can stand in if your first choice can't be reached or is incapacitated is a good idea.

Alternate healthcare agents aren't required, but it's a good idea to have one or two alternates ready in case your first choice can't be reached in an emergency, or in case the first choice is also incapacitated or unwilling to act.

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