Comparing a Typical Advance Medical Directive to the Farr Law Firm’s 4 Needs Advance Medical Directive®

Benjamin Franklin once said “(n)othing can be said to be certain, except death and taxes.” Today (April 16) is National Healthcare Decisions Day, a day for health care decision planning. And, in keeping with Franklin’s famous quote, each year National Healthcare Decisions Day is observed the day after Tax Day.

National Healthcare Decisions Day is a perfect day to think about and discuss the different types of health care and treatments you would and would not want, should something happen to you. An Advance Medical Directive (also known as a health care power of attorney; a health care directive; a health care proxy; and a living will) is a legal document you sign to provide guidance about what types of treatments you want to receive in case of a future, unknown medical emergency. A typical advance medical directive only specifies what medical-related actions should (or should not) be undertaken if you’re too ill or incapacitated to make decisions. The Farr Law Firm’s 4 Needs Advance Medical Directive goes several steps further by addressing what long-term care-related actions should or should not be undertaken for you and what after-death actions should or should not be taken for you.

A well-designed advance medical directive informs your loved ones and medical professionals who should speak for you and what medical decisions they should make if you are unable to speak for yourself. An advance medical directive is part of incapacity planning and estate planning. It is best to document your wishes with the help of an experienced estate planning attorney, such as the Elder Care lawyers at the Farr Law Firm.

The Farr Law Firm is a highly specialized Elder Law, Elder Care, and Estate Planning firm with locations in: Fairfax, Virginia; Fredericksburg, Virginia; Rockville Maryland; and the District of Columbia. Our proprietary 4 Needs Advance Medical Directive® covers the following four essential needs that should be covered by every Advance Medical Directive but are missing from most:

• Medical Power of Attorney
• Long-term Care Directive® (name and content is proprietary to the Farr Law Firm)
• Near-Death Directive® (this name is proprietary to the Farr Law Firm, but the content is similar to what you might find in a typical living will, or the living will section of a more comprehensive advance medical directive) and
• After-Death Directive® (name and content is proprietary to the Farr Law Firm)

First, I will discuss a typical advance medical directive and what it generally contains, and then I will delve deeper into our 4 Needs Advance Medical Directive® and the many benefits of having a more comprehensive plan in place.

What Is an Advance Medical Directive?

State and federal laws give you the right to make many health care decisions in advance so that your wishes can be honored in the event you can’t express them yourself. Here’s why you should have an advance medical directive in place:

• An advance medical directive is used to guide your health care team and loved ones when they need to make medical decisions or to decide who will make decisions for you when you can’t. These medical decisions may include special actions or emergency care from your health care team.
• It is your right, as a competent adult (a person over the age of 18), to decide whether to accept, reject, or discontinue medical treatment for yourself, for example. This includes decisions about life-sustaining treatments, such as breathing machines, feeding tubes, and end-of-life care.
• Having an advance medical directive in place gives you a chance to express whether you want to avoid unnecessary pain, unhelpful procedures, and unwanted hospitalization.
• With an advance medical directive, you appoint a health care agent to make decisions for you in case you become incapacitated. This is usually a family member or close friend who knows your values and is willing to make the types of decisions that you would make under similar circumstances, not someone who will try to impose their own wishes.
• Whether or not you feel strongly about organ donation, it is important to make your intentions known in an Advance Medical Directive if you want your wishes to be honored.
• An advance medical directive goes into effect only if you are incapacitated and unable to speak for yourself. This could be the result of illness or severe injury. No matter how old you are, an advance medical directive helps others know what type of medical care you want under different scenarios and situations when you are unable to speak for yourself.
• Documents such as an advance medical directive can help ensure that your loved ones and your health care team honor your wishes. Even though these situations can be uncomfortable to think about, planning in advance offers you and your family members peace of mind and helps eliminate confusion in a difficult time.

Advantages of the Farr Law Firm’s Proprietary 4 Needs Advance Medical Directive® Over a Typical Advance Medical Directive

As mentioned, here at the Farr Law Firm, we offer our proprietary 4 Needs Advance Medical Directive®. You can appoint an agent and give that person the power to consent to medical and health care decisions on your behalf. Similar to a typical advance medical directive, you can decide whether to withhold or withdraw a specific medical treatment or course of treatment when you are incapable of making or communicating an informed decision yourself. Here are some of the advantages of our proprietary 4 Needs Advance Medical Directive® over a typical advance medical directive:

• Similar to a typical advance medical directive, our proprietary After-Death Directive® and 4 Needs Advance Medical Directive® enable you to set forth your preferences with regard to burial or cremation, memorial service arrangements, disposition of remains, organ donation, and many other issues that arise after death.
  • In your 4 Needs Advance Medical Directive®, you also appoint an agent (and typically one or more alternates) and give that person the power to consent to medical and health care decisions on your behalf. This person can decide whether to withhold or withdraw a specific medical treatment or course of treatment when you are incapable of making or communicating an informed decision yourself.
  • You can also indicate your wishes concerning the use of artificial or extraordinary measures to prolong your life in the event of a terminal illness or injury.
• The most unique part of our 4 Needs Advance Medical Directive® is that it contains our proprietary Long-Term Care Directive® that allows you to address dozens of important issues that often arise if and when long-term care is needed and you’re unable to communicate your wishes. Typical advance medical directives simply ignore the entire issue of long-term care, even though 70 percent of people over the age of 65 will wind up needing long-term care, and over 11 percent of people over the age of 65 have Alzheimer’s disease or some other form of dementia.
• Our 4 Needs Advance Medical Directive® also includes an After-Death Directive that addresses organ donation in detail, and allows you to stipulate which organs you would want donated (for example, some people want to donate their brain or another organ, but not skin and bones, which are actually two of the most desired types of donor tissue). You can even name intended recipients if perhaps you have family members with kidney disease or some other organ disease who might be in need of a transplant.
• At the Farr Law Firm, we use DocuBank. DocuBank is an electronic storage and access service for health care directives. DocuBank stores all of your Advance Medical Directives, including your Living Will, Health Care Power of Attorney, HIPAA Release, organ donor wishes, funeral arrangements, and all other advance directives, so they are available whenever you need them.

Does an Advance Medical Directive Help Those with Dementia?

Most advance medical directives are not very helpful for patients who develop dementia. Typical advance medical directives address scenarios that are imminent, such as terminal conditions, being comatose, being incapacitated due to a car accident, etc., but they generally do not address gradual and progressive illnesses such as dementia. The Farr Law Firm’s proprietary Long-term Care Directive® does address the care needs associated with gradual and progressive illnesses because these illnesses typically require the need for long-term care. We also incorporate into our 4 Needs Advance Medical Directive® a very specific Dementia Directive.

Medical decisions for patients with dementia are typically made by health care agents because patients with dementia eventually lose decision-making capacity. These agents (who were likely named as an agent in an advance medical directive before the person had dementia) often experience enormous anxiety trying to guess their loved ones’ wishes. A Dementia Directive, which is a dementia-specific Advance Medical Directive, lessens this burden by providing some clarity about patients’ values and goals that can then help support decision making when a patient can no longer make decisions for themselves due to memory loss.

Our 4 Needs Advance Medical Directive® contains a Dementia Directive that addresses the changes in cognition that occur as dementia progresses, as well as the changes in goals of care that patients might want along the continuum of the disease. For instance, to address changes in the disease, our Dementia Directive lists:

• cognitive milestones of dementia grouped into four stages;
• developments that typically occur at each stage;
• determining whether the person with dementia would want full efforts to prolong his or her life, treatments to prolong life, care where he or she is living, or comfort-oriented (non-life prolonging) care only;
• deciding whether to use feeding tubes in late-stage dementia.

Without a legal document to use as a roadmap, clinicians unsure of the goals of care for such patients may continue to provide the same care they would have in the absence of dementia, without addressing whether plans should be adjusted. Clinicians and family members often find it easier to continue current treatment paths rather than really knowing whether such care is what a person with dementia would have wanted. Our Dementia Directive prevents this guesswork and instead ensures that your wishes get followed.

Document Your Decisions in Your 4 Needs Advance Medical Directive®

If you have not done Incapacity Planning (including our 4 Needs Advance Medical Directive® and Financial Power of Attorney), Estate Planning, or Long-Term Care Planning, or if you have a loved one who is nearing the need for long-term care or already receiving long-term care, please contact us as soon as possible. In addition, if your family is facing a diagnosis of Alzheimer’s or any other type of dementia, please call us to set up an appointment!

Northern Virginia Estate Planning Attorney: 703-691-1888
Fredericksburg, VA Elder Law Attorney: 540-479-1435
Rockville, MD Health Care Power of Attorney: 301-519-8041
Washington, DC Advance Medical Directive: 202-587-2797