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April 16 is National Health Care Decisions Day.

In recognition of this day, we would encourage everyone to have meaningful discussions with your family and friends about your wishes with regard to medical treatment decisions.

Your thoughts about medical treatment will no doubt change with age and health, and no one likes discussing end-of-life issues, but having had those hard talks is one way to lessen the stress and difficulty facing your loved ones. Physician offices, hospitals and nursing homes routinely question whether a patient has an advance directive or health care advance directive. This is because those questions are required of Medicaid and Medicare recipient providers by the federal Patient Self-Determination Act, after the Nancy Cruzan litigation. Batson Nolan suggests that everyone consider the scope and nature of medical treatment and intervention you want now and in the event of a major health event and that you share your preferences with your loved ones. These are the basics for your health care decision planning:

What is a health care advance directive?

A healthcare advance directive is the general description for any written document or statement you make while mentally competent concerning your future healthcare wishes and desires. These may include a living will and a healthcare power of attorney.

How do you prepare a health care advance directive?

We would encourage you to speak with your loved ones and those closest to you about your wishes and desires. We would also encourage you to speak with your physicians and those persons you would rely upon if you are injured or ill. As your health and relationships change, you should reconsider your wishes and desires. It would make sense that end of life options and care decisions may be very different in your 30s compared to the decisions you might wish to make in your 80s, or when faced with a catastrophic illness. Will doctors honor my health care advance directive? Generally speaking, doctors and healthcare facilities will want to honor your wishes. However, we would encourage you to speak with your primary care physician, and with any specialist if you are undergoing treatment for a serious or life threatening illness.

Who should I name as my agent or surrogate for health care decisions?

Obvious choices for surrogates or healthcare decision makers would be spouses and adult children. However it is very important for you to speak with this person beforehand and to explain your intentions. You need to be certain that this person is willing to act and comfortable in acting in this role. This may also mean having some very honest discussions about your health, your fears, and also about your final wishes. Ideally, you would want to involve and let others know of your wishes in order to avoid misunderstanding and conflict when it is time to implement your plans. The agent or surrogate that you select should be someone in close proximity to where you live or where you receive healthcare. In other words, do not pick a niece who lives in California as your healthcare agent if you reside in Tennessee.

What are the formalities in signing the documents?

Most states require witnesses and/or notary acknowledgements.

Is a health care directive made in Tennessee good across state lines?

It would be wise for your healthcare directive to be made in your state of primary residence. If you are planning on spending a significant amount of time in other states, then you should consider executing an advanced directive in that other state. In any event, providers will generally try to follow your wishes, regardless of the state of origin on the document you have prepared.

What kinds of decisions does a healthcare agent make?

A healthcare agent may have broad authority to consent to or refuse medical treatment for diagnostic procedures. This may include the right to consent to artificial nutrition (feeding tube) and/or hydration. A healthcare surrogate could make decisions about invasive surgical procedures or end-of-life treatment. A healthcare surrogate would also be permitted to change medical providers and authorize admission to medical and long term care facilities to include nursing home and assisted living facilities. A healthcare agent may also consent to measures for comfort and pain relief. A healthcare agent would need to have access to all of your medical records and to engage in conversations with your medical providers.

Where should you keep your healthcare directive?

It is wise to keep the original in a safe place where it can be easily found and we would suggest that you let your agent know where your advance directive is located. Also provide a copy to your physician, your healthcare surrogate or agent, and any loved one who is likely to be involved in your medical care. If you are a resident of an assisted living facility or nursing home, we would also recommend that the facility have a copy of your document. It may be wise to furnish a copy of the document to your attorney and to let your family members know that your attorney has the document as well.