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What are the important functions of an Advance Directive for Health Care?

Where I practice, in the state of Oklahoma, a standardized “Advance Directive” is offered to every patient when they are admitted to a hospital, or out-patient facility for any sort of procedure. There are several components to it.Living will - This covers what would happen if you were unable to communicate your wishes to your health care team - and - have an incurable and irreversible condition that even with the administration of life-sustaining treatment will, in the opinion of the attending physician and another physician, result in death within six (6) months. Do you want life sustaining treatment? If so, does that include artificial hydration and nutrition or just cardiovascular and respiratory (ventilator, etc.)? There are very specific scenarios described with check boxes for the most common choices and the ability to describe your wishes in more detail if desired.Appointment of a Health Care Proxy - Who can make decisions if you are not able to - a primary and contingent proxy are usually specified (in case you, say, appoint your wife, but she is in a car wreck with you, etc.)Anatomical Gifts - Do you want to donate your organs for transplantation - if so, which ones? Do you want to give your body for use as a medical school cadaver, etc.These are the high points. You can always come up with a more specific one.You may also want to designate someone as a “Power of Attorney” to help handle pending business affairs (not a part of the Advance Directive).Like writing a Will, it’s something people tend to put off, because it’s unpleasant to confront our own mortality - but I recommend doing both. Once it’s in place, you won’t have to deal with it any more, unless your circumstances or desires change.To look at the standard Oklahoma Advance Directive for Health Care - http://www.okdhs.org/OKDHS%20Publication%20Library/87-07W.pdfAnd for my theory on why people put off doing these things, see - Gary Larson's answer to What are some psychological facts that people don't know?If you are interested in “No Nonsense” answers to serious medical questions, please follow me. (>300 answers on cancer, medicine and human behavior.)

What is the intent of all those JW Blood Docs which state that two elders can put you in a nursing home if so choosing?

I will attempt to sincerely answer this question in two parts. In the United States, the Advance Directive most Jehovah’s Witnesses carries has a limited intent. That intent is to direct all medical professionals to respect our legal right to not have whole blood infused into our bodies if we become unable to make decisions.1. ADVANCE DIRECTIVEAn advance directive is a health care document by which a person makes provision for health care decisions in the event that, in the future, he/she becomes unable to make those decisions. This is a Legal health care document, and it is our personal choice. In case of unconsciousness the two individuals named on the document are then able to act as representatives in enforcing the document wishes. However they have no legal standing to go outside the documents wishes.Advance directive laws give doctors and others immunity if they follow your valid advance directive. This is the “carrot” the law provides to them. The only reliable strategy is to discuss your values and wishes with your health care providers ahead of time, to make sure they are clear about what you want, are willing to support your wishes, and they document your wishes.However it should be noted that Advance directives are legally recognized documents and doctors must respect your known wishes, but doctors can always refuse to comply with your wishes if they have an objection of conscience or consider your wishes medically inappropriate. Then, they have an obligation to help transfer you to another health care provider who will comply.2. CONSERVATORSHIPThe court-appointed conservator over the person is now responsible for managing the conservatee's placement, medical decisions, and mental health treatment. A court order can force someone to be placed in a nursing home.A conservatorship is very different than a Medical Directive.Generally, the person you choose to witness a document should be a disinterested party, or have no other interest in an agreement. Which in many cases excludes close family members.This is a very simplistic answer to this question. For a more complex answer see your attorney.

If I prepare an Advance Directive (Durable Power of Attorney and Living Will) for medical care, do I need a separate Advance Directive for mental health care?

It is very useful to have an Psychiatric Advance Directive. A psychiatric advance directive (PAD) is a legal plan that allows a person to specify important information for caregivers in the event of a mental health crisis. The PAD can provide valuable information for providers to reference and follow during that difficult time. The link above points to a place where you can get a form for the Advance Directive that will work in New Jersey.This is different from a health care power of attorney, because it lays out specifics about your psychiatric care if you should be incapacitated. These things include saying which drugs you respond best to; which psychiatrist you want to care for you; and even which hospital you should be taken to, if possible. In addition, you can appoint someone who has the power to make mental health decisions on your behalf.

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