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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Who can I contact with questions or for additional information?
At Froedtert Health, the Health Information Management Department is dedicated to assist you with Advance Directives. 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