Re: Assisted Suicide and Euthanasia
Although states have varying definitions of assisted suicide, in general, assisted suicide is the act of intentionally, knowingly and directly providing the means of death to another person so that the person can use that means to commit suicide. If the person who dies performs the last act, assisted suicide has occurred.
For example, if a doctor writes a prescription for an intentional overdose of drugs for a patient to use to commit suicide and if the patient who dies performs the last act (the act of swallowing), assisted suicide has taken place.
Assisted-suicide is sometimes called “aid-in-dying,” “death with dignity,” “physician-assisted death,” etc.
Euthanasia is the act of intentionally, knowingly and directly causing the death of a patient. If someone other than the person who dies performs the last act, euthanasia has occurred.
For example, if a person administers a lethal injection or puts a plastic bag over a patient’s head to suffocate him/her, euthanasia has taken place.
Euthanasia is sometimes called “aid-in-dying,” “mercy killing,” “death with dignity,” etc.
Re: Health Care Decision Making
An advance directive is a document by which a person makes provisions for health care decisions in the event that, in the future, he/she becomes unable to make those decisions. There are two main types of advance directive – the “Living Will” and the “Durable Power of Attorney for Health Care.” There are also combination advance directives which are hybrid documents that combine elements of the Living Will with those of the Durable Power of Attorney.
To be valid, an advance directive must comply with the law of the state in which it was signed.
A person who is designated in a durable power of attorney for health care to make health care decisions for the document’s signer.
An agent must be chosen very carefully since the agent will have great power and authority to make decisions about whether health care will be provided, withheld or withdrawn from the signer. It is extremely important that the signer discuss his/her values, wishes and instructions with the agent before and at the time the document is signed. Such discussions may also continue after the document is signed.
It is also important that the agent be willing to exercise his/her power and authority to make certain that the signer’s values, wishes and instructions are respected.
An agent may also be called an “attorney-in-fact,” “health care representative,” “health care surrogate,” “proxy,” etc.
Combination Advance Directive
A combination advance directive is a legal document that contains elements of both the Living Will and the Durable Power of Attorney for Health Care. Generally, it includes specific written directions that are to be followed by the attending physician and by the agent.
Although intended to provide the benefits of both the Living Will and the Durable Power of Attorney for Health Care, a combined document actually incorporates the problems of the Living Will and, therefore, lessens protection for its signer.
It may severely limit the discretion and flexibility that the agent needs and may restrict the agent’s authority in a way the signer did not intend. In addition, the specific written directions may not be altered through discussions between the signer and the agent. Any changes necessitate a new document to reflect nuances or changed directions.
A conservator is an individual appointed by a court to make personal decisions, including health care decisions, for an incompetent individual.
A conservator may also be called a “guardian.”
Durable Power of Attorney for Health Care
A Durable Power of Attorney for Health Care is a signed, witnessed (or notarized) document in which the signer designates an agent to make health care decisions if the signer is temporarily or permanently unable to make such decisions. The agent, “standing in the patient’s shoes,” receives information about the patient’s diagnosis, prognosis, treatment and care options, and other information that the patient would have received. Then, the agent makes health care decisions on behalf of the patient. The signer selects an agent who may, but need not be, a family member and who is familiar with the patient’s views and values.
Since it is a legal document, the wording of the Durable Power of Attorney for Health Care should be meticulously drafted to provide protection for the signer and to prevent ambiguity that could threaten the authority of the named agent to protect the signer. The Protective Medical Decisions (PMDD), which is available from the Patients Rights Council, has been drafted in this manner.
Unlike most Living Wills, the Durable Power of Attorney for Health Care does not require that the signer have a terminal condition.
A Durable Power of Attorney for Health Care may also be called a “Protective Medical Decisions Document,” “Designation of a Health Care Representative,” “Health Care Power of Attorney,” Designation of a Health Care Surrogate,” etc.
A Living Will is the oldest type of health care advance directive. It is a signed, witnessed (or notarized) document. Most Living Wills instruct an attending physician to withhold or withdraw medical interventions from its signer if he/she is in a terminal or irreversible condition and is unable to make decisions about medical treatment.
Since an attending physician who may be unfamiliar with the signer’s wishes and values has the power and authority to carry out the signer’s directive, certain terms contained in the document may be interpreted by the physician in a manner that was not intended by the signer. Family members and others who are familiar with the signer’s values and wishes have no legal standing to interpret the meaning of the Living Will.
A Living Will may also be called a “Directive,” “Declaration,” “Individual Health Care Instruction,” etc.
A principal is the person who executes (signs) an advance directive.
In most states, a surrogate is any individual who has authorization to make health care decisions for another person. However, in California, a surrogate is an adult, other than a patient’s agent or conservator, who is orally designated by the patient to make health care decisions for a limited duration. Under California law, a patient may designate a surrogate by personally informing the supervising health care provider during a stay in a health facility or at the time of treatment for an illness. Unless the patient specifies a shorter time, the surrogate is authorized to make decisions during the course of treatment, during the stay in the facility, or for 60 days (whichever period is shortest).
Other terms, including POLST, Terminal Sedation, VSED and Physician-Assisted Dying