Advance Directives & Care Planning

Keeping The Peace: A guide to planning for medical, financial, and legal issues at end of life.

Ever wonder how your loved ones will survive if you are not around? By maintaining a file of important documents, you will be ensuring your affairs are in order and that you are helping to keep the peace after you are gone.

Use the information provided in this guide to gather vital details about your legal matters, health, financial affairs, instructions, and more. Create a file with copies, or the location, of the suggested items in this guide, and keep it in a secure location. Valuable and practical, it will be a tremendous gift for your loved ones, allowing them to heal and keep the peace.

Note: This guide contains general information and is being provided as a resource to the general public. It is not intended to substitute for the advice of an attorney or physician about your specific situation. Every individual’s situation is different, and you should not make estate or healthcare plans based solely on information contained in this packet without first consulting legal counsel. Since laws change over time, the information in this guide may not necessarily reflect the most current legal developments at the time it is distributed.  The distributor of this packet assumes no liability or responsibility for any errors or omissions in its content.

What is an Advance Directive?

An Advance Directive is used to tell your doctor and family what kind of medical care you want if you are too sick or hurt to talk or make decisions. If you do not have one, members of your family will have to decide on your care.

You must be at least 19 years old to set up an Advance Directive. You must be able to think clearly and make decisions for yourself. You do not need a lawyer to set one up but you may want to talk with a lawyer before you do this. Whether or not you have an Advance Directive, you have the same right to get the care you need.

Deciding About Your Health Care

If you are 19 or older, the law says you have the right to decide about your health care. If you are very sick or badly hurt, you may not be able to say what medical care you want or don’t want. If you have an Advance Directive your doctor and family will know what medical care you want or want to refuse.

The law says doctors, hospitals, nursing homes, hospices, and home health agencies must do what you want or send you to another place that will do so. Hospice of West Alabama will respect your wishes and your Advance Directives.

It is most important that your family know your wishes. Explain to them why you want the care you have decided on and find out if they are willing to let your wishes be carried out.

Family members do not always want to go along with an Advance Directive. This often happens when they are not informed about a patient’s wishes ahead of time or are not sure of your wishes. Talking to them ahead of time can prevent this problem.

Types of Advance Directives

In the State of Alabama, the choices you have include the following:

  • A living will is used to write down ahead of time what care you do or do not want if you are too sick to speak for yourself.
  • A proxy can be part of a living will. You can name a proxy to speak for you and make choices you would make if you could. If you pick a proxy, you should talk to that person ahead of time. Be sure your proxy knows how you feel about different kinds of medical treatments.
  • Another way to name a “proxy” is to sign a durable power of attorney.

You can choose to have any or all of these three advance directives: living will, proxy and/or durable power of attorney. Our hospice social workers have forms you can fill out if you want to set up any of them. For questions, you may ask your own lawyer or call your local Council on Aging for help.

What You Need to Decide

You will need to decide if you want treatments or machines that will make you live longer even if you will never get well or if you do not want to be resuscitated if your heart stops and you stop breathing, i.e., “Do Not Resuscitate” or “DNR”.

You may also decide if you want food and water through a tube or just to be kept comfortable. Your hospice nurse and physician can help tell you about the pros and cons of these treatments.

Setting Up an Advance Directive

Be sure to sign your name and write the date on any form or paper you fill out. Talk to your family, doctor, and nurse or social worker so they will know and understand your choices. Give them a copy of what you have signed. If you go to the hospital, give a copy of your advance directive to the person who admits you to the hospital.

You Can Change Your Mind at Any Time

As long as you speak for yourself, you can change your mind any time about what you have written down, if you make changes, tear up your old papers and give copies of new forms or changes to anyone who needs to know. Please tell your nurse or social worker about changes.

Making an Alabama Advance Directive for Health Care Legal

The law requires that you sign your document, or direct another to sign it, in the presence of two witnesses, who must be at least 19 years of age.

Your witnesses cannot be:

  • your appointed health care proxy,
  • related to you by blood, adoption or marriage,
  • entitled to any portion of your estate upon your death, either through your will or under the laws of interstate succession,
  • directly financially responsible for your medical care, or
  • the person who signed your document on your behalf.

These witnesses must also sign the document to show that they personally know you, believe you to be of sound mind, and that they do not fall into any of the categories of people who cannot be witnesses.

Note: You do not need to notarize your Alabama Advance Directive.

Hospice of West Alabama Statement of Limitations

Hospice of West Alabama is not equipped with emergent life sustaining equipment in any patient care setting. If the patient/family choose emergent life sustaining measures Hospice of West Alabama staff will initiate CPR and call 911.

Additional Help or Information on Advance Directives

University of Alabama Elder Law Clinic: 205-348-4960

NHPCO CaringInfo: 800-658-8898

36 Items Needed to Ensure Your Affairs Are In OrderOther Things To Consider List

Terms Related to Advanced Planning

Advance directive – A general term that describes two kinds of legal documents, living wills and medical powers of attorney. These documents allow a person to give instructions about future medical care should he or she be unable to participate in medical decisions due to serious illness or incapacity. Each state regulates the use of advance directives differently.

CPR (Cardiopulmonary Resuscitation) – A group of treatments used when someone’s heart and/or breathing stops. CPR is used in an attempt to restart the heart and breathing. It may consist only of mouth-to-mouth breathing or it can include pressing on the chest to mimic the heart’s function and cause blood to circulate. Electric shock and drugs also are used frequently to stimulate the heart.

DNI (Do-Not-Intubate) order – A DNI order is a physician’s written order instructing healthcare providers not to intubate. This means that chest compressions and cardiac drugs may be used, but no breathing tube will be placed.

DNR (Do-Not-Resuscitate) order – A DNR order is a physician’s written order instructing healthcare providers not to attempt cardiopulmonary resuscitation (CPR) in case of cardiac or respiratory arrest. A person with a valid DNR order will not be given CPR under these circumstances. Although the DNR order is written at the request of a person or his or her family it must be signed by a physician to be valid. A non-hospital DNR order is written for individuals who are at home and do not want to receive CPR.

EMS (Emergency Medical Services) – A group of governmental and private agencies that provide emergency care, usually to persons outside of healthcare facilities; EMS personnel generally include paramedics, first responders, and other ambulance crew.

Hospice – A program designed to provide palliative care and emotional support to the terminally ill in a home or homelike setting so that quality of life is maintained and family members may be active participants in the care. Hospice care may also be provided in freestanding hospice centers, hospitals, nursing homes, and other long-term care facilities.

Intubation – Refers to “endotracheal intubation” the insertion of a tube through the mouth or nose into the trachea (windpipe) to create and maintain an open airway to assist breathing.

Life-sustaining treatments (may also be called life support treatments) – Treatments (medical procedures) that replace or support an essential bodily function. Life-sustaining treatments include cardiopulmonary resuscitation, mechanical ventilation, artificial nutrition and hydration, dialysis, and other treatments.

Living will – A type of advance directive in which an individual documents his or her wishes about medical treatment should he or she be at the end of life and unable to communicate. It may also be called a “directive to physicians,” “healthcare declaration,” or “medical directive.”

Medical power of attorney – A document that allows an individual to appoint someone else to make decisions about his or her medical care if he or she is unable to communicate. This type of advance directive may also be called a healthcare proxy, durable power of attorney for healthcare, or appointment of a healthcare agent. The person appointed may be called a healthcare agent, surrogate, attorney-in-fact, or proxy.

Palliative care – A comprehensive approach to treating serious illness that focuses on the physical, psychological, spiritual, and existential needs of the patient. Its goal is to achieve the best quality of life available to the patient by relieving suffering, and controlling pain and symptoms.

Power of attorney – A legal document allowing one person to act in a legal matter on another’s behalf regarding to financial or real estate transactions.

Ventilator – A ventilator, also known as a respirator, is a machine that pushes air into the lungs through a tube placed in the trachea (breathing tube). Ventilators are used when a person cannot breathe on his or her own or cannot breathe effectively enough to provide adequate oxygen to the cells of the body or rid the body of carbon dioxide.

Withholding or withdrawing treatment – Forgoing life-sustaining measures or discontinuing them after they have been used for a certain period of time.