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Advance directives let you make life decisions

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By Pamela Yip
Thursday, June 27, 2013, 12:01 a.m.

When it comes to your health and the kind of medical care you receive, you want to maintain as much control as possible.

That's why, as you age, it becomes critical to draw up an advance directive, or living will, clearly stating your wishes about life-sustaining treatments when you reach the point that you can no longer decide for yourself.

Note that this isn't the same as a medical power of attorney, in which you appoint a person to make decisions about your medical care if you are unable to communicate. With an advance directive, you make the decisions.

Drawing up an advance directive is important for everyone, but it's particularly critical for those who have been diagnosed with Alzheimer's disease or any other form of dementia.

“The Alzheimer's Association encourages all individuals to prepare advance directives, which remove the burden of difficult care decisions from the caregivers and ensures the wishes of the diagnosed individual are respected and implemented,” said Debra Adams, vice president of programs and services at the Alzheimer's Association's Greater Dallas chapter.

Here's what you need to know on advance directives.

Start early

Patients diagnosed in the early stages of Alzheimer's should start on their advance directive while they're still lucid, experts said.

“One of the advantages of getting a diagnosis early is so the person can complete their directives and other legal and financial documents while they are still competent to do so,” said Kay Paggi, a Dallas geriatric care manager.

That's critical, elder law attorneys said.

“If you're the attorney, you always try to not have somebody sign documents that you provide to them if you don't think they're lucid enough to understand what they're signing,” said John McNair, elder law attorney at Barnett McNair Hall LLP in Dallas.

“You don't just sign” an advance directive, McNair said. “You have to make a decision.”

If someone “is unable to make those choices about their care that are required in properly completing an advance directive, then they probably lack the capacity to care for their own health,” he said.

Dementia provision

“Most advance directives take effect only when a person is unable to make health care decisions and is either permanently unconscious or terminally ill,” said Barbara Coombs Lee, president of Compassion & Choices, an end-of-life choice advocacy and support group. “But what of the situation in which a person suffers from severe dementia but is neither unconscious nor dying?”

Compassion & Choices has made available a provision that can be added to any advance directive to advise physicians and family of the wishes of a patient with Alzheimer's or other dementia.

“It's pretty unique because if you're looking at someone who's terminally ill and mentally competent to make a contemporaneous decision, a person with Alzheimer's will never meet those dual criteria,” Lee said. “When they're mentally competent, they won't be in the terminal phase of their illness, and when they're in the terminal phase of their illness, they won't be mentally competent.”

Here's an example of the language in Compassion & Choices' dementia provision:

“If I am unconscious and it is unlikely that I will ever become conscious again, I would like my wishes regarding specific life-sustaining treatments, as indicated on the attached document entitled My Particular Wishes, to be followed. ”

Tell your family

Make sure your family knows what you want — and tell them early on.

“You want the whole family to hear your wishes,” Lee said. “You want the whole family to agree so there's no infighting or dissension of, ‘What would Mom want?' ”

Dallas elder care lawyer Michael Cohen helps his clients develop a “personal care plan” that enables them to coordinate their advance directive with their wishes in such areas as living arrangements, how they want to be dressed when they're buried and what they want placed on their tombstone.

“We try to customize to the individual whatever it is that they desire,” he said. “It's their life, not anybody else's.”

Although anyone can create a personal care plan, “it's more imminent for those who already have had a diagnosis (of dementia),” Cohen said.

“If there are certain specific directions that you want to give, this may be your last shot to how you want to be treated when you're out of it,” he said.

Pamela Yip is a personal finance columnist for the Dallas Morning News. She can be reached at; she cannot make individual replies.

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