Care For PA

In Pennsylvania, capacitated adults have the right to decide whether to accept, reject or discontinue medical care and treatment. There may be times, however, when a person cannot make his or her wishes known to a health care provider. For example, a person may be incompetent, in a terminal condition, or in a state of permanent unconsciousness, and unable to tell his or her doctor what kind of care or treatment he or she would like to receive or not to receive. This can be addressed through developing a living will and/or health care power of attorney.

By law, health care providers must provide necessary medical care to all individuals within their care. They are relieved of this duty only if they can demonstrate that the care goes against a person's wishes. If you have preferences about the physical or mental care you want to receive in the event you are not able to express your wishes, you may want to write a living will for physical and/or mental health care (also called an "advance directive�?), as well as a physical and/or mental health care power of attorney.

What is a Living Will/Advance Directive?

A living will, or advance directive, is a legal paper in which you spell our your preferences for care.

What is a Physical or Mental Health Power of Attorney?

It is a legal paper in which you spell out who can make decisions about your physical and/or mental health care if you are not able to make such decisions yourself. The person you authorize to make these decisions is called your "agent.�?

When Do They Go into Effect?

Both a physical health living will and power of attorney goes into effect only if you have a terminal medical condition or are in a state of permanent unconsciousness, and your doctor determines you are incompetent to make medical decisions.

A mental health advance directive and power of attorney goes into effect when you are incapacitated and unable to make decisions for yourself, as determined by a psychiatrist and a second mental health professional who have examined you. It also could be triggered by some other circumstances that you put in your living will or power of attorney (such as when you exhibit certain symptoms).

How Long Are They Effective?

For physical health living will and power of attorney, there is no termination date. Both are effective as long as they are not rescinded or until a new one is signed.

Both a mental health advance directive and power of attorney automatically terminate two years after being signed, unless they are in operation at the time. If in operation at the end of the two-year period, the documents terminate once you recover your capacity to make mental health decisions. Your attending physician determines when you regain capacity.

What If I Change My Mind?

You may revoke or change your living will/advance directive and health care power of attorney at any time, unless it is in operation. Collect and destroy the old documents and distribute any revised documents that you may have created.

What Should I Consider When Making Decisions About a Living Will/Advance Directive and Power of Attorney?

The most important thing is to express your wishes or give permission to your agent to make decisions for you about receiving or not receiving certain forms of medical treatment that would keep you alive. You may also wish to indicate your wishes regarding organ and tissue donation.

It is important to consider your own personal situation and treatment history when writing these documents, including the conditions under which you would want the advance directive or power of attorney to be used. Examples of things you may want to include are preferences for treatment (such as a preferred facility, medication choices, and consent certain therapies), as well as information about family notification, child custody arrangements while you are ill, what seems to help you recover, or anything else of importance to you.

If you're preparing a mental health advance directive, keep in mind that your psychiatric and other health conditions may change from the time you signed the documents to the time they are used, so that the medications or treatments you allow in the advance directive are no longer appropriate. To help avoid this, consider specifying your preferences without being overly restrictive, giving your treatment providers choices. It will also help to prepare your advance directive in consultation with your psychiatrist or attending physician so that you are fully informed when you make your choices.

Does a Health Care Power of Attorney Mean I Have to Appoint a Lawyer to Make Health Care Decisions for Me?

No. You are allowed to appoint anyone you wish as your agent. You should appoint someone you know, trust, and with whom you can talk over your wishes. Your agent will have the rights and responsibilities that you have unless you state otherwise, including access to your medical records, the ability to make decisions regarding voluntary commitment for inpatient treatment, consent to medications and therapy, and participation in drug trials.

Do I Need Separate Physical and Mental Health Advance Directives and Powers of Attorney?

It's important to note that you are not required to have a living will/advance directive or health care power of attorney to receive treatment.

If you wish to express your preferences for care or name an individual to make decisions on your behalf, you will want to consider writing a living will/advance directive, power of attorney, or both. Even though you may include mental health care preferences in a physical health living will, it is advisable to develop a separate mental health advance directive and mental health power of attorney.

Where Should I Keep My Living Will/Advance Directive and Power of Attorney?

Give a copy of your living will/advance directive and power of attorney to your family doctor and other health care providers you regularly see, your lawyer, your family, and to those people you have named as your agent. You also should bring a copy with you when you are being admitted to a hospital or other health care facility.

Are There Times When My Living Will/Advance Directive Will Not Be Followed?

Although it will usually be followed, there are times when it will not be.

Pennsylvania law generally does not permit a doctor or other health care provider to honor the living will of a pregnant woman who has directed that she not be kept alive. However, if you are pregnant, your living will may be honored if your doctor determines that life-sustaining treatment will: (1) not maintain you in a manner that will allow for the continued development and birth of your unborn child; (2) physically harm you; or (3) cause you pain that cannot be relieved by medication. If your living will is not honored because you are pregnant, the Commonwealth must pay for your care.

Your psychiatrist or other mental health professional will follow your mental health advance directive unless he or she believes that the treatment you requested is medically inappropriate. In such cases, he or she will transfer your care to another provider who is willing to comply with the directive. If that is not possible, you may be discharged if it is safe to do so. There may be situations when your health insurance company will not authorize payment for the treatment that you requested, which may impact your ability to get that treatment. If your condition is very serious but your mental health advance directive prevents treatment that would keep you from harm, a court may invalidate all or part of the advance directive and allow treatment that will help you. The effect of an involuntary commitment on a mental health advance directive is unclear. To avoid problems, it is important for you to talk with your psychiatrist or attending physician about your advance directive and power of attorney before you need to use them.

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