Making sure your wishes are known

Kottkamp Each day families and health-care providers struggle with making difficult medical decisions when patients who are unable to speak for themselves don’t have an advance directive in place that outlines their wishes.

That’s why national, state and community organizations are leading a massive effort to highlight the importance of advance health-care decision-making – an effort that has culminated in the formal designation of April 16, 2010, as National Healthcare Decisions Day.

“We purposely set the date for National Healthcare Decisions Day for April 16, the day after taxes are due,” explained Richmond attorney Nathan Kottkamp, founder and chair of National Healthcare Decisions Day. “Nothing is certain but death and taxes.”

Kottkamp hopes the event will help “educate people about advance health-care decision- making and also encourage them to think about, discuss and document their wishes in the event they cannot speak for themselves at some point.”

National Healthcare Decisions Day focuses on two groups: the public and health-care providers. Kottkamp hopes that people will not only think about their wishes but also name an agent who could communicate those wishes for them if they were unable to do so themselves.

“We also want to be sure that providers are honoring those wishes,” he said, adding that providers should ask patients if they have some type of advance directive in place.

Most people understand the importance of having a regular will, but many aren’t aware that an advance directive is essential, as well. There are three major types of advance directives: a health-care power of attorney or designation of agent; a living will, a written statement of your health-care wishes; and organ donation choices.

“There is also a corollary type that is a psychiatric advance directive that was authorized by law in 2009 that covers someone when they are having a psychiatric episode and can’t speak for themselves,” Kottkamp said.

The single most important document is the designation of agent where someone is appointed to make medical decisions for you in the event that you can’t make those decisions yourself.

“A living will expresses your wishes, but it’s hard to anticipate everything that will happen,” Kottkamp explained. “The person [you designate] can talk with doctors and nurses and come up with a game plan. That is more helpful than a single piece of paper guiding things.”

These documents need to be in place early on.

“You should probably have a will and a medical [advance] directive as soon as you become an adult,” noted N. Leslie Saunders Jr., senior managing partner of Saunders, Cary & Patterson.

Advance directives are essential for certain groups such as the gay and lesbian population because life partners are not authorized by law in Virginia to make decisions for their partners. The responsibility falls to a member of the family, which may not be the person you want making that decision.

Saunders suggests that you keep the finalized documents in a safe place at home or in a safety deposit box.

“Let your family know where they are,” he said. “You should also provide the name of someone who can go into your safety deposit box [if you cannot].”

Some people put off getting an advance directive because they think they will need the help of an attorney. That isn’t the case. Free forms are available on the Internet as well as any Virginia hospital.

“One of the easiest places to get them is on www.nationalhealthcaredecisionsday.org,” Kottkamp says. “At the top of the page you will find resources, and at the bottom you will see a set of Virginia resources maintained by the Virginia State Bar.”

The forms you complete do not have to be notarized, but they do need to be witnessed.

“In Virginia you do need to have two witnesses to the advance directive, but they can be anybody,” Kottkamp said. “You can have your loved ones be your witnesses.”

If you prefer to go through an attorney, it would be best to find one that does trusts and estates, elder law or general family law.

“You may want to inquire to see if they do advance directives,” Kottkamp said.

Debbie Leidheiser, the county’s senior advocate, suggests everyone make this a priority.

“I encourage all people to have an advance directive to make their health-care decisions known – regardless of age or current health,” she said. “It’s essential to have this conversation with your family in advance, and it’s a discussion that should take place in the living room, not in the hospital waiting room when it may be too late.”