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As you age, you may be thinking more about your medical treatment plans and future decisions. There may come a time when you are unable to voice your opinions about your healthcare needs, which can create considerable hardship for your family members.
Creating an advance directive gives you a voice in the future, even if you can no longer speak for yourself.
Working with an advanced healthcare directive lawyer is the best way to ensure your medical decisions are known and to eliminate any guesswork for your family.
Our team at the Law Offices Of Ericson, Scalise & Mangan, PC, is here to help you create legally sound documents to ensure your wishes are respected and followed. Please call us today to schedule a consultation if you have any questions about advance directives or would like to learn more about our team.
What is an Advance Directive?
An advance healthcare directive is a broad term that can include multiple legal documents. All of the documents in a healthcare directive are meant to protect your best interests when getting medical care.
Creating advance directives ensures that your health care and medical treatment preferences are followed should you become incapacitated and unable to speak for yourself. Advance health care directives can also allow your appointed agent and medical professionals to access your records to make informed decisions.
One of the primary advantages of advance directives is that they eliminate the guesswork and stress many families face when making critical medical decisions for their loved ones. Anyone at least 18 years old and of sound mind should consider creating advance directives.
Advance directives may include:
- Living Will. A living will is a written statement that describes your medical wishes for the future, such as preferences for life support systems if you are terminally ill.
- Do Not Resuscitate (DNR) Order. A DNR order instructs medical professionals not to attempt to revive you if your heart stops.
- Medical Orders for Life-Sustaining Treatment (MOLST). In this document, you can dictate the treatments you do or do not want for end-of-life care.
Living Will/Health Care Instructions: States your preferences for life-sustaining treatments (like ventilators, feeding tubes) if you’re terminally ill or permanently unconscious.
What is the Difference Between a DNR vs. a Living Will?
A common question among Connecticut residents is the difference between a Do Not Resuscitate (DNR) and a living will. Although both involve medical care, they differ in key ways.
Do Not Resuscitate Order (DNR)
A DNR is a physician’s order directing medical staff to withhold all forms of CPR. The order prohibits any lifesaving actions, including chest compressions, defibrillation, and breathing support, if you stop breathing or your heart stops.
A DNR order applies only to resuscitation efforts and takes effect only upon cardiopulmonary arrest. It is recommended that the order be posted so that first responders or EMTs can see it upon entry.
Living Will
Unlike a DNR, which only goes into effect when you begin to experience cardiopulmonary arrest and only prohibits specific actions, a living will covers a broader scope of medical actions. Some of the most common medical conditions addressed by a living will include the use of ventilators, feeding tubes, artificial nutrition and hydration, and other life-support systems.
A living will is designed to be effective if you can no longer make decisions about your health care or end-of-life matters. That being the case, a physician must interpret the living will and determine that you have a terminal condition.
If you have concerns about the differences between a DNR and a living will, it is best to consult a knowledgeable attorney who can answer your questions.
Why is it Important to also include a MOLST Document in My Advance Directives?
One of the most essential documents that should be included in your advance directive is a Medical Orders for Life-Sustaining Treatment (MOLST). Having an MOLST ensures that your health care wishes are followed in real time.
With an MOLST in place, your health care preferences are turned into actionable medical orders for first responders or health care providers. Often, advanced health care directives do not take effect until you have entered a hospital, so having an MOLST helps emergency medical personnel understand your wishes without a doctor having to decide.
The MOLST goes a step further than other advance directives by clarifying your choices and helping your family avoid unnecessary confusion or guesswork about what you do or do not want.
As with other advance directives, an MOLST must be signed by a doctor and should travel wherever you go. Having an MOLST is also ideal because it provides clarity and consistency across your home, hospital, or nursing home.
Although anyone of age can benefit from having a MOLST, they are invaluable for those who are terminally ill or of advanced age.
What is an Appointment of Healthcare Representative in Connecticut?
In Connecticut, an Appointment of Healthcare Representative is an advance directive that authorizes your appointed agent to act on your behalf without court intervention. This legal document allows your agent to make medical decisions on your behalf if you are unable to make your own decisions or communicate your wishes. One of the primary advantages of an Appointment of Healthcare Representative is that it helps to prevent you from being subject to a court-appointed conservatorship.
Once you have appointed your agent, they can make decisions regarding medical treatments, surgeries, and stopping life-sustaining care. The decisions that your agent makes will be based on your preferences or what medical professionals advise is in your best interest. This legal document complements a living will, helping ensure your representative acts in accordance with your wishes.
When choosing an agent, you must select someone you trust, who understands your values, and who can handle stressful situations if they arise.
What are some Common Medical Conditions that Can Trigger the Use of an Advance Directive?
Under Connecticut law, only specific medical conditions qualify for an advance directive. To make informed decisions about your wishes, you must understand the health conditions that trigger the use of an advance directive or that of an Appointment Healthcare Representative.
Under the law, a living will only takes effect when an individual is in a terminal condition or permanently unconscious. Permanently unconscious includes an individual being in a permanent coma or persistent vegetative state. Conversely, an Appointment of Health Care Representative is initiated when a person becomes incapacitated.
Medical conditions that can trigger an advance directive include:
Dementia and Alzheimer’s
Dementia and Alzheimer’s are two of the most common medical issues that Connecticut families face, which could lead to legal issues if an advance directive has not been created beforehand. Although the family member may not be able to make decisions due to their cognitive decline, they are not considered to be permanently unconscious or have a terminal condition. That being the case, your health care agent can make medical decisions and prevent the matter from potentially going to court.
Stroke or Traumatic Brain Injury
Strokes are a leading cause of incapacity among adults in Connecticut. In many instances, the damage from a severe stroke can leave an individual unable to speak or swallow, conditions that require a ventilator or feeding tube. These conditions can trigger the “permanently unconscious” clause contained in a living will. Patients who do not have a living will that states their preferences regarding artificial nutrition and hydration, such as feeding tubes, are often placed on life support systems.
Terminal Organ Failure
Several diseases that affect older adults, such as congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and end-stage renal disease, can quickly result in terminal organ failure. These diseases can escalate quickly, often resulting in an individual needing to be intubated. The use of a respirator can trigger the terminal condition clause in a living will. A thorough living will should provide details as to an individual’s preferences for the use of CPR or ventilators as opposed to comfort measures provided through hospice care.
What Can Happen if I Do Not Have Advance Health Care Directives and Suddenly Become Incapacitated?
Many individuals mistakenly believe they do not need advance directives until they are older or develop a serious illness. The truth is that anyone could suddenly become injured or ill to the point that medical decisions need to be made on their behalf.
If you do not have an advance healthcare directive in place and suffer permanent unconsciousness, your family could be forced to guess as to your healthcare wishes. Health care providers will generally look to your adult family members, such as your spouse, children, or parents, to make decisions. Even so, under Connecticut law, when circumstances like this arise, and you do not have a health care agent, no one has automatic authority to make decisions.
One of the dangers of not having advance directives is that if your family cannot agree on the type of medical care that you should receive, the probate court will be forced to appoint a conservator. The court-appointed conservator will then have the legal authority to make decisions regarding your health care.
Depending on the circumstances involved, the court may appoint an individual to oversee your care that you would not have chosen and whose choices do not align with your wishes, especially when it comes to making end-of-life decisions.
To ensure that your family and loved ones do not have to deal with the stress and expense of potentially having to go to court.
Why Should I Hire a Lawyer to Help Me With Advanced Health Care Directives?
As with any legal matter, hiring a lawyer is the most effective way to ensure that your legal documents adhere to state law, withstand court scrutiny, and help avoid unnecessary family disputes.
Complies With All Legal Guidelines
Because the purpose of an advance directive is to ensure that your wishes for medical care and end-of-life decisions are honored, it is crucial that you have a lawyer who will review the documents for accuracy and ensure they meet legal standards. For example, your living will and Appointment of Healthcare Representative are signed and acknowledged by a notary public.
Your lawyer will also help you articulate your wishes into legal language that leaves no doubt about the type of medical care you do or do not wish to receive.
Addressing Challenging Circumstances
Depending on the circumstances, you will need a legal representative who can handle complex situations that may be involved in your case. It is important to remember that every case is different, and you will need a lawyer who has the legal foresight to handle these situations so you and your family are protected.
Minimizing the Risk of Family Disputes
Even though you may believe that your family is aware of and willing to honor your final wishes, your loved ones may not agree on your care if you become terminally ill and cannot speak for yourself. The last thing you want is for your family to have to go to court or engage in a legal dispute that could cost them money or disrupt your medical care.
Can I Make Changes to My Health Care Instructions?
Because circumstances in your life can quickly change, there may be a time when you need to amend or revoke your healthcare instructions on your advance directives. Even so, there are specific steps you must follow to ensure your wishes are up to date and aligned with any changes you want to make.
Create New Documents
Your first action will be to complete a new living will and Appointment of Health Care Representative. It is highly recommended that you obtain qualified legal representation to help you make the necessary changes so that your documents can hold up to legal scrutiny. The new documents must align with your current instructions and be signed and dated correctly.
After completing the new documents, you will need to give copies to health care providers, health care proxy, and family members. You must also destroy all previous versions to avoid confusion and prevent inadvertent use.
When You Should Consider Making Changes
Even if your medical wishes remain the same, situations may arise that will create a need to revise or amend advance directives, including:
- Profound changes in your health or newly identified medical conditions
- A significant life event, such as a marriage or divorce
- Your health care representative can no longer serve
If you need to update your advance directives, contact the Law Offices Of Ericson, Scalise & Mangan, PC today, and we will help determine which options suit your needs.
Do Advance Directives Expire in Connecticut?
In Connecticut, advance directives do not expire. Even so, if you created a living will several years ago, your wishes and medical conditions may have significantly changed. In some instances, medical professionals may be hesitant to adhere to the documents due to the time that has passed since they were created.
As with other estate planning documents, we advise our clients to review and initial their advance directives every five years to ensure they remain consistent with their current wishes and that their health care proxy remains able or willing to serve.
Although the Five D’s rule is not a Connecticut law, it does serve as a guide for when you should review your advance directives. The Five D’s rule includes:
- Decade: Starting a new decade
- Death: Death of a spouse, child, or close friend
- Divorce: A divorce or any other major family change
- Diagnosis: A new, serious medical condition
- Decline: A substantial decline in your health
Can a Doctor refuse to Honor My Advance Directive?
Under Connecticut law, health care providers may refuse to comply with a living will if it conflicts with their religious or conscience-based beliefs. Other scenarios that could occur that may cause your physician to refuse to honor your advance directive include:
- The advance directive violates hospital policy or accepted medical standards
- If there is a DNR in place, the provider or EMS would be forced to override
Nevertheless, in most cases, properly executed advance directives will be honored by your medical providers. One of the easiest ways to ensure your advance directives are followed when the time comes is to have honest conversations with those responsible for your care.
If, for some reason, your attending physician does not wish to honor the advance directive, they are legally obligated to transfer your care to a medical professional or health care facility that will respect your preferences.
Can My Health Care Representative resign?
Yes, your health care representative can resign if they decide that is the best option for them. Being a health care proxy is entirely voluntary, and there are often many reasons to step away from serving as your representative.
For example, many individuals who initially agree to fill the role find it too emotionally draining and request to be replaced. In other instances, many couples designate each other as their health care representative should the need arise. Even so, life can change quickly, and one spouse may become ill or be in poor health, preventing them from acting entirely in the other’s best interests.
The best strategy is to name an alternate or successor representative who can step into the role if the primary choice resigns, becomes incapacitated, or cannot be located. If you do not choose an alternate to act as your health care representative, it could result in delays or even court intervention.
Can I use my Advance Directive to become an organ donor?
Another common question clients ask our attorneys is whether they should use their advance directive to designate themselves as an organ donor. In Connecticut, the standard advance directive form includes a section titled “Document of Anatomical Gift.” On the form, you can mark whether you would like your organs to go to medical or dental science, or identify specific ones, such as eyes or kidneys, depending on your personal preferences.
While some individuals choose to make their preferences known through advance directives, many others indicate them on their driver’s licenses. No matter what you decide to do, it is always best to discuss your choices with your family ahead of time so there will be no disputes or surprises should you suddenly become ill or incapacitated.
Will My Advance Directive Work in Another State?
Many older adults enjoy traveling or heading south in winter to seek a warmer climate. While a Connecticut advance directive will most likely work in other states, transferability is not guaranteed. Depending on the state you are traveling to, they may have different laws or witness requirements that can invalidate your directive, especially in matters concerning end-of-life care. Out-of-state physicians may also be unfamiliar with the terms outlined in the directive, which could cause delays or disputes.
Before traveling to another state or planning to be gone from Connecticut for an extended time, it is best to find out more about the other state’s advance directives laws so you can make informed decisions.
Should You Consult an Advance Directive Attorney?
Everyone can benefit from an advance directive. Whether you are perfectly healthy or you have a serious illness, noting your medical decisions now protects you from harm in the future. If you are incapacitated or in an accident, your advance directive provides the guidelines for your loved ones to follow.
If you’re interested in creating an advanced healthcare directive, contact our team of attorneys today. We can recommend specific legal documents that meet your healthcare goals. We will also update your advance directive regularly as your circumstances change. For more information, call the Law Offices Of Ericson, Scalise & Mangan, PC in New Britain at 860-854-3809 or Avon at 860-854-3545 today.
