If you are unable to make decisions, who will make decisions about your medical treatment? (Advance Directives)

Imagine, whether due to an accident or a medical condition like Alzheimer's disease, someone is unable to make decisions about themselves. At such a time, who decides, 'I want this kind of treatment', 'I shouldn't do these things'? This is something we all need to think about. There are things we can legally do to prepare for such an unexpected situation in advance. That's what we're talking about today.

What are these Advance Directives?

Simply put, an Advance Directive is a legal document that tells you in advance what medical treatment you want or don't want if you become unable to make decisions about your health in the future.

Imagine if someone fell into a coma or suffered a complete loss of memory, and they couldn't say what they wanted to happen to them. That's when this document becomes important. It lets doctors and family know exactly what your wishes are.

There are two main types of Advance Directives:

These Advance Directives can be divided into two main types. It is very important to understand the difference between the two.

Let's take a closer look at a 'Living Will'

This is a legal document. It allows you to decide in advance whether or not you will receive life support procedures if you become incapacitated, terminally ill, or permanently unconscious.

For example, if you stop breathing, this document can tell you whether you will be put on a respirator or not. In some countries, the law also considers giving food and water through a tube to be life-supporting treatment in cases of incurable coma.

Most importantly, a Living Will will only be effective after two doctors have confirmed that you are terminally ill or in a coma from which you cannot recover.

What is a 'Healthcare Power of Attorney'?

This is also called a 'Health Care Proxy'. With this document, you appoint someone you trust to make health care decisions for you if you are unable to make decisions for yourself. This appointee is called an 'agent'.

This condition can be temporary, caused by an accident, or permanent, caused by an illness. Unlike a Living Will, you don't have to be terminally ill for this to be effective. This document is valid at any time you lose the ability to make decisions .

You can appoint anyone over the age of 18 as this representative. However, you cannot appoint the doctor who is treating you or any of his or her staff. The representative you appoint will not be financially responsible for your treatment. You can name several other representatives to replace the first representative if they are unable to do so.

How do I make an Advance Directive?

Anyone over the age of 18 who is of sound mind can prepare such a document.

• You can ask your doctor for a form for this.
• Or you can write down what you want clearly on a piece of paper.
• Sometimes there may be sample documents related to this on the Department of Health's websites.
• It would also be a good option to seek the assistance of a lawyer regarding this.

For this document to be legal, it must be signed by two adult witnesses , or it must be notarized . Since laws vary from country to country, it is best to check with your lawyer about the legal situation in Sri Lanka.

You can also cancel this document at any time. There are several things you can do to do this:

• Tearing and destroying the document.
• Saying loudly that it will be canceled in front of witnesses.
• Written notice of cancellation.

In many hospitals and clinics, when you are admitted, they ask you or your family if you have such a document. They also record it in your medical chart.

What is the difference between Advance Directives and DNR Orders?

This is where many people get confused. An Advance Directive is not a "Do Not Resuscitate" (DNR) order.

A DNR order is a written order from a doctor stating that cardiopulmonary resuscitation (CPR) should not be given if someone's breathing or heartbeat stops.

Even with an Advance Directive, you may still need to receive treatment for a treatable condition, such as pneumonia. A DNR is a different, more specific medical order. So don't confuse the two.

Something beyond documents...

As important as creating a legal document like this is, perhaps even more important, talking openly about this with your family and your doctor .

Keep them informed about your wishes and the treatments you want at the end of your life. That way, when it's the hardest time to make a decision, it will be easier for them to carry out your wishes. That's a big strength for them too.