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Make your medical instructions clear, detailed and comprehensive

Colorado law establishes avenues for people to direct their medical care should they become incapacitated and unable to do so. A recent study raises the issue of how important it is for a person to include in their advance directives instructions that are specifically tailored to that person's needs, wishes and medical conditions.

To put the study in context, we will begin by briefly describing the advance directives available in the Centennial State.

Colorado advance directives: living wills and health care agents

First, Colorado law provides that a person may execute a living will that gives doctors treatment instructions should the person find him or herself in a vegetative state or with a terminal illness without the capacity to make personal and medical decisions. Colorado statute formally calls this legal document a "declaration as to medical treatment."

Second, a person may appoint a specific person to make medical decisions should the appointing person become unable to do so, if incapacitated following an injury or illness or at the end of life. Colorado law calls this a "medical durable power of attorney" and the person so appointed is sometimes called a health care agent. In the legal document that appoints a health care agent, the person drafting it, called the principal, may include specific directions for the agent in case of certain medical events.

The legal documents that create these advance directives can be as detailed as the writer prefers regarding preferences for nutrition, hydration, surgery, life-sustaining procedures like resuscitation and other medical treatment. The more specific the direction, the easier it will be for doctors, appointed agents and family members to determine what the patient would have wanted. This can also provide comfort to the health care agent because he or she can go forward knowing the patient's wishes were carried out.

The Mayo Clinic study

This week, the results of a Mayo Clinic study were published that looked at the use of advance directives by patients with kidney failure on dialysis by reviewing medical records over a recent five-year period. According to the study abstract, despite kidney failure that requires dialysis being associated with an increased rate of death and cognitive impairment, only about half of the 808 patients reviewed had advance directives.

The abstract reports that about 25 percent of dialysis patients stop dialysis at the end of life. Still, of those with advance directives in the study, only 10.6 percent mentioned dialysis at all, with only 3 percent addressing "dialysis management at end of life." Several other medical decisions and treatments were more often addressed in the advanced directives, despite dialysis being a huge issue at end of life for patients with this medical condition.

The study concludes that research should look at how to improve kidney-failure patients' "discernment and documentation of end of life values, goals, and preferences, such as dialysis-specific advance directives ..."

A Colorado expert weighs in

Dr. Sara Ann Combs, affiliated with the VA Eastern Colorado Health Care System and the University of Colorado School of Medicine, reviewed this new study in an accompanying article. She writes that the type of patient studied faces complicated medical decisions at end of life that should be made in collaboration with doctors and those who will serve as health care agents after careful review of the medical evidence and treatment options available to the patient in possible future scenarios, in light of the individual's "goals and values."

Lessons from study universally relevant

Every Coloradan is wise to discuss the execution of advance directives with an estate planning attorney. While the Mayo study looks only at dialysis patients, the lessons learned are important to anyone creating an advance directive. As part of that process, the person should talk about his or her particular health issues with a physician in detail to understand the potential medical treatment decisions that could arise. Then, considering the person's own feelings and preferences, he or she needs to provide comprehensive, detailed guidance to future health care agents and medical providers in a living will or medical power of attorney, or both, as appropriate. Legal counsel can help the client draft and execute these crucially important documents as part of comprehensive future planning.

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