More on Advanced Health Care Directives

The Uniform Health-Care Decisions Act of Mississippi (MCA §41-41-201, -209) describes the “Advance Health-Care Directive” (AHCD) as the instrument by which a person with mental capacity can designate an agent who will be able to make health-care decisions for the maker. In the event you lose capacity through illness or injury, medical providers may be reluctant to render non-emergency treatment without consent of someone with lawful authority to approve such measures. The AHCD allows you to control and direct personal health-care decisions after the onset of any future incapacity.

Section 1 of the AHCD is the health-care power of attorney, in which one or more persons may be listed in the maker’s order or choice and designated as agents to make medical and health-care treatment decisions for you, the maker. You can select whether the agent may make such decisions without prior determination of your incapacity, or whether one or more doctors must first determine the your incapacity before the agent can make decisions. In Section 2, you can state any personal health-care decisions, for example: keeping or removing life-support treatments or tube-fed food and liquids in the event of terminal illness, and other choices concerning medical treatment based on the maker’s own personal values. In the optional Section 3, you can list the name and contact information about her personal physician. Section 4, added in 2006, allows organ donation instructions in the directive.

In light of the stringent privacy regulations under the Health Insurance Portability and Accountability Act (HIPAA) governing the release of personal medical information, it is wise to include specific language in the AHCD that identifies the agent as your “personal representative” who is entitled to request and receive your medical information for HIPAA purposes.

The AHCD is not enough. Healthcare decisions are emotional and deeply personal You should communicate personal values to family members. The law generally requires that a health-care agent, to the extent he has reason to know the decision that the principal would make for himself under the circumstances, must make that decision also. This is called the “substituted judgment” rule, because the judgment of the incapacitated person must be substituted for the independent decision of the agent. If the agent has no basis to know what the principal would choose in the situation, then the agent must act in the best interest of the principal (the “best interest” rule). Therefore, you must discuss your values and choices about medical care and end-of-life treatment to your designated agent before the need to use the directive arises.