If you become unable to express your wishes, how will you have a say in your medical care? The answer is Advance Directives — simple legal documents that let you appoint a health care decision maker and specify your basic health care preferences. If you do not bring Advance Directive(s) with you, you can get the necessary forms (and assistance filling them out) by contacting the Health Information Management Department at 414-805-2909. Do Advance Directives "lock you in" to certain choices? No. You can cancel or replace your directives at anytime.
You have the right to make decisions about your health care. This includes the right to accept or refuse medical or surgical treatment. You also have the right to plan and direct the types of health care you may receive in the future if you become unable to express your wishes. You can do this by making an Advance Directive document.
Get Started With Your Advance Directive Forms
There are two ways to make a formal Advance Directive in Wisconsin.
It is best to have a Power of Attorney for Health Care (POAHC) 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. However, the State of Wisconsin requires two 'defined' 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.
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, 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.
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.
Power of Attorney for Health Care (POAHC)
The Power of Attorney for Health Care is a document in which you appoint another person known as 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 proper forms. These areas are:
- Admission to long-term care facilities
- Limitations on mental health treatment
- health care decisions for pregnant women
- Pregnancy care
- Provision of a feeding tube
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 don't want when you complete the form.
A Power of Attorney for Health Care goes into 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.
A Living Will is a document that informs your physician that you want to die naturally should you develop an illness or injury that is terminal or you are in a persistent vegetative state. A Living Will allows you to refuse treatment or machines which may keep your heart, lungs or kidneys functioning when they are unable to function on their own. A Living Will may also communicate your choices about feeding tubes and other life-sustaining procedures.
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.
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.
Other Links and Resources for Advanced Directives
We provide these links as a convenience for patients and visitors to this site. We are not responsible for the content of external sites.
- Center for Practical Bioethics — The Center has a 20-year history of raising and responding to ethical issues in health and health care.
- Consumer’s Tool Kit for Health Care Advance Planning — The American Bar Association Commission on Law and Aging provides this helpful site.
- Five Wishes — The Five Wishes document is a popular form that looks at all of a person's needs: medical, personal, emotional and spiritual.
- National Hospice and Palliative Care Organization — This group provides state-specific documents and instructions.
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. While most people have thought about their end-of-life preferences, many do not have an advance directive. A study by the Pew Research Center found 95% of Americans had heard of a living will and 29% had a living will.
NHDD was founded in 2008 by Nathan Knottcamp, an attorney in Virginia. Knottcamp’s goal was to make clear and consistent information about health care planning available to patients, their families and health care providers. Advance care planning starts at age 18. While that may seem young, it is helpful to plan ahead for unexpected illnesses or injuries.
The Wisconsin Department of Health and Human Services recommends considering the following questions when it comes to advance care planning:
- Do you have an advance directive?
- Have you thought about if you want to request a do-not-resuscitate (DNR) order?
- Are you an organ donor, or do you want to be?
- Who has access to your health information?
- Should you talk to a lawyer?
A free guide is available to help you begin the advance care planning conversation with your loved ones.