As part of an estate plan, most people have a Health Care Directive, which addresses whether or not you want artificial nutrition and hydration administered if you are diagnosed with a terminal and/or permanently unconscious condition. Most estate plans also include a Durable Power of Attorney for Health Care Decisions, which appoints a person to act as your agent to make health care decisions on your behalf if you are incapacitated. For people with mental health conditions, a Mental Health Advance Directive may also be part of their estate plan.
None of these documents, however, allow a person to express their wishes for their own care if they develop dementia. While your health care agent acting under your Durable Power of Attorney for Health Care would have authority to make decisions on your behalf if you are unable to do so due to dementia, how do you communicate your wishes about your care to your agent?
The New York Times reported earlier this year that a University of Washington physician has developed an advanced directive for patients with dementia that allows people to express their wishes for future care, should they develop dementia. A New York organization is developing a similar directive addressing advanced dementia care. Like a Health Care Directive or a General Durable Power of Attorney for Health Care Decisions, any advance directive for dementia care must be prepared while you still have the mental capacity to understand the document and your decisions. However, it is questionable as to whether a health care provider would follow an advanced directive related to dementia care absent statutory authority similar to the statute governing Health Care Directives. It would be helpful if the Washington legislature addressed this issue.
As important as it is to include any advance medical directives in your medical file, it is equally important to discuss your wishes concerning your care to family members or others who might be making medical decisions on your behalf if you are incapacitated. The vast majority of us would prefer not to develop dementia in the first place. Unfortunately, it doesn’t work that way. It is possible, however, to plan.
Photo credit: Charles O’Rear