If you become unable to express your wishes, how will you have a say in your medical care? The answer is advance care planning. Advance care planning is both a conversation and the creation of legal documents about what is most important to you and how you want your medical care to look. The creation of advance care planning documents is the best way to communicate your wishes.
Why Advance Care Planning Is Important
- You have the right to make decisions about your health care.
- You have the right to plan and direct the types of health care you may receive in the future.
It is recommended that every person over the age of 18 complete a Health Care Power of Attorney document. It is important to choose a person to express your wishes and make health care decisions in the event that you are unable to do so for yourself.
There are two recognized advance care planning documents in Wisconsin.
Health Care Power of Attorney
It is important to have a Health Care Power of Attorney document. This allows you to formally choose a health care agent to make decisions for you in the event you are unable to make decisions for yourself. A lawyer or notary is not required to complete these forms.
Getting Started on Your Health Care Power of Attorney
The forms require the information listed below:
- Your legal name, address and date of birth
- Choose one or two people to be named as your health care agents. Include their current address and phone number(s).
- You will answer questions about giving your agent(s) the ability to make decisions for you in specific situations that may or may not happen in the future. These situations are specific to the State of Wisconsin Health Care Power of Attorney. If you do not give your agent(s) permission, their ability to make decisions may be limited in certain situations.
- You will need two witnesses who are not your health care agents or related to you by blood, marriage, domestic partnership or adoption.
The Difference Between a Living Will and Power of Attorney for Health Care
A Living Will is a legal document that lets you share your wishes for medical care or life-sustaining treatments if you are ever in a vegetative state or have a terminal condition. It does not name a health care agent.
When there is a conflict between what you direct in a Living Will and what you direct in a Power of Attorney, the Power of Attorney takes precedence.
If you have questions about the Health Care Power of Attorney form or need assistance to complete a document, please contact the Enterprise Care Coordination Department to speak with a social worker at 414-454-4747. There is no cost involved.
If you already have a completed document, you can:
- Bring this to your next appointment.
- Upload the document to MyChart.
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Advance Directive Topics to Discuss
Before having your health care agent sign any forms, you should discuss your beliefs and wishes with him or her. When you become incapacitated and they need to make health care decisions, however we suggest you consider the following questions. We suggest no particular answers. Each person should answer these questions based on his or her own beliefs and convey those beliefs and wishes to their health care agent. Any other wishes or desires that you feel your health care agent should know, should also be given to them so that they can carry out their responsibilities.
25 Suggested Topics to Discuss With Your Health Care Agent
- Do you think it is a good idea to sign a legal document that says what medical treatments you want and do not want when you are dying? (This is called a "Living Will.")
- Do you think you would want to have any of the following medical treatments performed on you?
- Kidney dialysis (used if your kidneys stop working).
- Cardiopulmonary resuscitation, also called CPR (used if your heart stops beating).
- Respirator (used if you are unable to breath on your own).
- Artificial nutrition (used if you are unable to eat food).
- Artificial hydration (used if you are unable to eat fluids).
- Do you want to donate parts of you body to someone else at the time of your death? (This is called "organ donation.")
- How would you describe your current health status? If you currently have any medical problems, how would you describe them?
- If you have any current medical problems, in what ways, if any do they affect your ability to function?
- How do you feel about your current health status?
- If you have a doctor, do you like him or her? Why?
- Do you think your doctor should make the final decision about any medical treatments you might need?
- How important is independence and self-sufficiency in your life?
- If your physical and mental abilities were decreased, how would that affect your attitude toward independence and self-sufficiency?
- Do you wish to make any general comments about the value of independence and control in your life?
- Do you expect that your friends, family and/or others will support your decisions regarding medical treatment you may need now or in the future?
- What will be important to you when you are dying (e.g., physical comfort, no pain, family members present, etc.)?
- Where would you prefer to die?
- What is your attitude toward death?
- How do you feel about the use of life-sustaining measures in the face of terminal illness?
- How do you feel about the use of life-sustaining measures in the face of permanent coma?
- How to do you feel about the use of life-sustaining measures in the face of irreversible chronic illness (e.g., Alzheimer's disease)?
- Do you wish to make any general comments about your attitude toward illness, dying and death?
- What is your religious background?
- How do your religious beliefs affect your attitude toward serious or terminal illness?
- Does your attitude toward death find support in your religion?
- How does your faith community, church or synagogue view the role of prayer or religious sacraments in an illness?
- Do you wish to make any general comments about your religious background and beliefs?
- What else do you feel is important for your agent to know?
If, over time, your beliefs or attitudes in any area change, you should inform your health care agent. It is also wise to inform your health care agent of the status of your health when there are changes such as new diagnoses. In the event you are informed of a terminal illness, this, as well as the ramifications of it, should be discussed with him or her.
Resources
National Healthcare Decision Day
National Healthcare Decision Day (NHDD) is observed on April 16 each year. Events on the day are held across the country to raise awareness about the importance of advance care planning. NHDD events provide educational resources about advance directives and organizers can assist people with creating and filling out the form.
Advance Directive Frequently Asked Questions
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What is an Advance Directive?
An Advance Directive is actually several types of documents: Power of Attorney for Health Care, Living Will, DNR Bracelets and Financial Power of Attorney. These are documents that legally tell in writing either who you would wish to make your health care decisions for you in the event that you are unable to do so, or provide guidance to your physicians regarding how you would wish your health care be decided in the event that you have a terminal condition or are in a persistent vegetative state.
An Advance Directive expresses your personal wishes and is based upon your beliefs and values. When you make an Advance Directive, you will consider issues about life-sustaining procedures such as ventilation, feeding tubes or other procedures you wish or may not wish in the event you are in a terminal condition or persistent vegetative state. An Advance Directive does not include decision-making for mental health issues or treatment.
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Who can make an Advance Directive?
In Wisconsin, if you are 18 years of age or older, are able to make decisions, and of "sound mind", you can make an Advance Directive.
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Why should I make an Advance Directive?
An Advance Directive speaks for you when you are unable to do so and directs your wishes regarding health care decisions. It may relieve your family from the burden of guessing what you would want because it tells others the care and treatments you do or do not want and/or who will make health care decisions for you when you cannot express your wishes.
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How do I make an Advance Directive?
There are two ways to make a formal Advance Directive in Wisconsin. You can complete either a Living Will and/or Power of Attorney for Health Care document. These forms are available from your health care provider or can be obtained from the Division of Health. It is best to have a Power of Attorney for Health Care document as this document designates someone to make decisions for you in the event you are unable to make decisions for yourself. You do not need a lawyer to complete these forms.
These forms are available free of charge at Froedtert Health locations through the Health Information Management department. The State of Wisconsin requires two persons to witness your signature on the forms. If you complete the forms at home, the witnesses must be at least 18 years old, not related to you, and not benefiting from your estate. -
What is a Living Will?
A Living Will informs your physician that you want to die naturally if you develop an illness or injury that is terminal or you are in a persistent vegetative state. It allows you to tell the physician what your medical treatment preferences would be in the event you are near death or in a persistent vegetative state.
A Living Will allows you to refuse treatment or machines which keep your heart, lungs or kidneys functioning when they are unable to function on their own. You can relate your choices about feeding tubes and other life sustaining procedures in this document.
A Living Will goes into effect only when two physicians, one of whom is your attending physician, agree in writing that you are either near death and are unable to understand or express your health care choices, or are in a persistent vegetative state that cannot be reversed. The implementation of a Living Will becomes the responsibility of your physician, not your family.
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What is a Power of Attorney for Health Care?
The Power of Attorney for Health Care is a document in which you appoint another person (a "health care agent") to make health care decisions for you in the event you are not capable of making them for yourself. When you complete this document, you give authority to your health care agent to make a wide range of decisions for you, such as whether or not you should have an operation, receive certain medications, have a feeding tube placed or be placed on a life support system. In some areas of health care, your health care agent is not allowed to make decisions for you unless you give him or her specific authority in these areas when you complete the form. These areas are admission to long-term care facilities, limitations on mental health treatment, health care decisions for pregnant women, pregnancy care and provision of a feeding tube.
Because your health care agent (HCA) will make decisions for you based upon what he or she knows about you and thinks is best for you, it is important to choose someone who knows you well and will honor your wishes.
It is important to discuss your treatment preferences with your health care agent. You can include specific instructions about the type of treatments you want or do not want (such as surgery or tube feedings) when you complete the form.
A Power of Attorney for Health Care goes in effect only when two physicians, or a physician and a psychologist, agree in writing that you can no longer understand your treatment options or express your health care choices to others.
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What is the difference between a Living Will and Power of Attorney for Health Care?
A Living Will goes into effect only when your death is very near or when you are in a persistent vegetative state and have no cognitive abilities to make medical decisions. It deals only with the use or non-use of life sustaining measures.
A Power of Attorney for Health Care also goes into effect when you can no longer make health care decisions (incapacitated), but you do not have to be close to death or in a vegetative state. The Power of Attorney for Health Care allows another person to speak for you and make health care decisions for you that are not limited to life-sustaining measures. The type of decisions this person can make depends upon the extent of authority you give when you complete the form.
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Should I have both a Living Will and a Power of Attorney?
It is not necessary to have both a Living Will and a Power of Attorney for Health Care. If you do have both documents, you should make sure they do not conflict. If they do conflict, a health care provider will follow the instructions of a Power of Attorney for Health Care. In general, it is better to have a Power of Attorney for Health Care rather than a Living Will.
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What if I change my mind?
You can cancel or replace a Living Will or a Power of Attorney for Health Care at any time. The different ways you can do this are explained on the forms you complete when you make the documents. This includes executing a written statement that is signed and dated by you which states your intent to revoke the document, verbalizing this intent in the presence of two witnesses or creating a new Power of Attorney for Health Care document.
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Does my health care provider have to follow my Advance Directives?
Some health care providers and physicians may have policies or beliefs which prohibit them from honoring certain Advance Directives. It is important to discuss your Advance Directives with these people to make them aware of your wishes and to determine if they will honor your Advance Directives. If a physician or provider is unwilling to honor your wishes, the physician or provider must make a good faith effort to refer you to a physician or provider who will meet your needs.
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What happens if I don't make an Advance Directive?
You will receive care if you do not make an Advance Directive. However, there is a greater chance you will not receive the types of care and treatments you want if you have not made an Advance Directive.
If you cannot speak for yourself and have not made an Advance Directive, a physician will generally look to your family, friends or clergy for decisions about your care. If the physician or health care facility is unsure, or if your family is in disagreement about the decision, they may ask a court to appoint a person (guardian) who will make decisions for you. You or your family members may be responsible for making arrangements for these legal services and the fees to appoint a guardian.
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Where should I keep my Advance Directive?
You should keep your Advance Directive in a readily accessible place where family/friends can locate it. You should make sure your family members, physician and your lawyer, if you have one, know you have made an Advance Directive and know where it is located. Bring a copy of this document when you come to the clinic. The document will remain on file in your medical record at Froedtert Health. Our patient care staff will ask for updates each time you visit.
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What are Froedtert Health's policies on Advance Directives?
Froedtert Health respects and upholds an individual's rights under state law to make health care decisions, including the right to accept or refuse medical or surgical treatment and the right to formulate Advance Directives.
Neither Froedtert Health nor any physician or other health care professional on the hospital's or clinic's staff will condition the provision of health care or otherwise discriminate against an individual based on whether or not the individual has executed an Advance Directive.
Froedtert Health has adopted a detailed policy on Advance Directives. The following requirements from that policy are applicable to both Powers of Attorney for Health Care and Living Wills.
A Power of Attorney for Health Care or a Living Will must be physically produced at the hospital or clinic in order to be given effect.
Legible photocopies or electronic facsimile copies of an original Power of Attorney for Health Care or of an original Living Will are presumed to be as valid as the original.
A Power of Attorney for Health Care or Living Will that appears to have been voluntarily executed and witnessed in accordance with its terms and applicable requirements of Wisconsin law will be presumed valid.
The provisions of a valid Power of Attorney for Health Care supersede any directly conflicting provisions of a Living Will.
In the event of any inconsistency between hospital or clinic policy and Wisconsin law, Wisconsin law will control.
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Who can I contact with questions or for additional information?
If you have additional questions, you may also contact any of the following:
- Your personal attorney
- Wisconsin Division of Health: 608-266-8475
- Elder Law Center/Coalition of Wisconsin Aging Groups: 608-224-0660
- Wisconsin Board on Aging and Long Term Care (Ombudsman Program): 608-266-8944
- Wisconsin Department of Health and Family Services Division of Disability and Elder Services Bureau of Quality Assurance: 608-267-7119