Healthcare Decision-Making and the Law
Making healthcare decisions for individuals with medically fragile conditions, such as power of attorney, proxy and end of life preferences, are governed by New York State and federal laws. It is important to understand some of the basic definitions of the legal requirements of these decision making milestones.
Durable Power of Attorney: Often called “power of attorney with durable provisions.” Under a durable power of attorney, the authority of the attorney to act and/or make decisions on behalf of the named individual continues until the individual’s death. It permits an attorney/agent to make financial decisions on behalf of that individual and to engage in asset protection planning for long term care and estate purposes.
Health Care Proxy: A durable power of attorney or proxy can also be a “healthcare power of attorney”, which empowers another person to make healthcare decisions for an individual, in keeping with an individual’s values and wishes, up to and including the power to consent, refuse consent or withdraw consent to any type of medical care, treatment, service or procedure.
Living Will: A living will or advance healthcare directive reflects one’s wishes as they relate to end of life care. It is a written statement of a person’s healthcare and medical wishes. It does not appoint another person to make healthcare decisions but in the case of a child with a medically fragile condition, the guardian or individual with power of attorney may also be a proxy (see above), empowered to make decisions on behalf of the individual. Depending upon the state, a healthcare power of attorney may or may not be bundled with an advance healthcare directive in a single document. New York State, however, has a Health Care Proxy law that requires a separate document be prepared appointing an individual as one’s healthcare agent.
MOLST (Medical Orders for Life Sustaining Treatment) Form (42): A MOLST form is intended for individuals with life threatening health conditions who:
- Want to avoid or receive any or all life-sustaining treatment
- Reside in a long-term care facility or require long-term care services
- Might die within the next year
The MOLST form is one way of documenting a patient’s treatment preferences concerning life-sustaining treatment – providers may choose to use other forms. However, under New York State law, the MOLST form is the only authorized form in New York State for documenting both non-hospital DNR (Do Not Resuscitate) and DNI (Do Not Intubate) orders. In addition, the form is beneficial to individuals and providers as it provides specific medical orders and is recognized and used in a variety of health care settings.
An excellent explanation of this document can be viewed at the MOLST link above.