Much has been written about the requirements for executing advance directives such as powers of attorney, designation of a health care representative, living wills, arrangement for organ donation, and do not resuscitate orders.  Giving thought to any of these directives is a good idea in advance of the need for them - for seniors, their caregivers, and people of all ages.  Today I am thinking more about some of the things that can go wrong, or should I say go differently than anticipated with respect to advance directives.  For example:

1) The law in Indiana is that a designation of health care representative, more commonly known in other states as a health care power of attorney, is only effective when the principal is not able to make decisions.  Notice that in our documents the power to make decisions for someone else is usually prefaced by the words “whenever I am incapable of making my own health care decisions.”  That sounds clear enough, but in reality, a health care facility cannot practically decide, on a day to day basis when their patient is capable or not capable.  This tends to lead to a bias to ask the health care representative what care should be given, even when the principal is competent to make the decision.  It is the representative that may be paying the bills.  It is the representative who made the admission decision and has the most interaction with some of the staff. The point is that we must guard against allowing health care providers to always ask the representative.  It is the patient that should have input, if possible.


In my next couple of blog entries, I'll give more examples of how things can progress differently than expected...