- What is an advance directive?
- What is a Power of Attorney for Healthcare (POAHC)?
- What is the difference between a POAHC and Living Will?
- What is the importance of a POA for healthcare?
- How do I get information about creating a Power of Attorney for Healthcare or some other written document to express my views about future medical care?
- How do I complete a power of attorney for health care document?
- Once completed, what do I do with the document?
- Who can be my healthcare agent?
- Does my agent need to live close by?
- I don’t want to go to a nursing home. If I check ‘yes’ under agent authority for a nursing home, will this mean I will get sent to one?
- What does a feeding tube and/or IV mean?
- CPR choices on the document: what are the differences?
- How do I change the document if I want to make changes?
- Questions related to autopsy and organ donation.
- When may I sign my POAHC for healthcare?
- When can my health care agent make my medical decisions?
- What should I do when I travel?
- Does my family already have authority to make my decisions for me?
- Should I update my basic advance directive if I develop a serious, incurrable illness?
1. What is an advance directive?
An advance directive is any plan you have made regarding future health care decisions. It may be expressed orally in conversation with your family or in writing. There are many types of written, legal documents that are advance directives. Two of these are a living will and a power of attorney for health care. [Return to Top
2. What is a Power of Attorney for Healthcare (POAHC)?
A power of attorney for health care is a legal document recognized by state statute that allows you to appoint another person and alternate person to make your medical decisions if you become incapable of doing so. The person or persons you appoint are typically called health care agents. This legal document also allows you to provide instructions about what type of medical care you do and do not want under future circumstances. This document typically is the best one for most individuals. [Return to Top
3. What is the difference between a POAHC and Living Will?
The main difference between a power of attorney for health care and a living will is that a power of attorney for health care allows you to legally authorize another person or persons to make health care decisions when you are incapable. A living will only allows you to provide instructions about when you would not want certain medical care. For most people, the power of attorney for health care is the most effective, flexible document and it is the best document to use when you can appoint another person to make your decision if you become incapable. [Return to Top
4. What is the importance of a POA for healthcare?
In Wisconsin the power of attorney for health care is especially important. Not only does it provide you a way to appoint a health care agent to make your medical decisions when you are incapable and to provide any instructions that you want to express, but it provides you a way to give authority to your health care agent to make certain decisions like admission to a long term care facility. Without such a document your family or loved one may not be able to make certain decisions on your behalf. Then, they either will be forced to petition the courts to make these decisions and pay the legal expenses or they will be forced to continue life-sustaining treatment, even if they think you would not want it. [Return to Top
5. How do I get information about creating a power of attorney for health care or some other written document to express my views about future medical care?
You can find information at this web site including electronic files that contain an information booklet and a planning guide. A copy of the power of attorney for health care document and a tutorial about how to complete it are also available at this web site. If you want more information or need assistance, you can call 608-775-1347. [Return to Top
6. How do I complete a power of attorney for health care document?
First, it is best to simply to read through the document and to work through the planning guide. Next, have a thoughtful discussion with those close to you who you would like to be involved in your medical decisions should you become incapable. The planning guide, found as an electronic file on this web site, will guide you through the process of reflection and discussion. After this process, you should start to fill in the document. There is a tutorial on line at this web site that will work you through the process of completing the document. If you need personal assistance, please call (608) 775-1347. [Return to Top
7. Once completed, what do I do with the document?
Once you have completed the document, you should make copies for each of the persons you have listed as your healthcare agent. One copy should also be given to the health organization where you receive care. You should keep the original document for yourself. When giving a copy to your health care organization, you can either give a copy to your physician at your next visit or, if you are a patient at Gundersen Health System, you can send it to: Gundersen Release of Information 1900 South Ave., CB0-004, La Crosse, WI 54601.
Once the POAHC document has been received by Gundersen, it will be scanned into your medical record. The document will become accessible to you via MyCare with the options to view and download onto your computer.
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8. Who can be my healthcare agent?
Typically a healthcare agent is a family member, a close friend, or sometimes a pastor/religious leader or neighbor. The person or persons you select should be someone you trust; is willing to speak with you about your values, goals and preferences regarding medical care; is willing to honor your views; and can be a strong advocate when faced with decisions that are difficult. When you are admitted as patient of a health care facility, you cannot appoint any employee of that facility or any health professional that is providing your care, unless this person is closely related to you. [Return to Top
9. Does my agent need to live close by?
NO. With modern communications, we can typically contact anyone in a timely fashion. The most important thing is that the person you select will be a strong advocate in your behalf and we are provided with all the phone numbers for the person(s)that are available. [Return to Top
10. I don’t want to go to a nursing home. If I check ‘yes’ under agent authority for a nursing home, will this mean I will get sent to one?
No, when you selected “yes” for this question, you have only given your health care agent authority to make such a decision. If you do not give your health care agent this authority, then a court will make the decision about a need for a nursing home. Allowing the court to decide is costly and seldom, if ever, changes the decision of going to a nursing home. [Return to Top
11. What does a feeding tube and/or IV mean?
A feeding tube or IV means the provision of food and fluids through a tube, either by a pump or gravity. Such a tube may go directly into a vein, through your nose into your stomach, or may be surgically inserted through your abdominal wall into your stomach. [Return to Top
12. CPR choices on the document: what are the differences?
What is CPR?
CPR is done for you by someone else. It can include:
• Breathing into your mouth and pressing on your chest
• Electrical shock and drugs to try to start your heart
• A tube to help you breathe
Does CPR work?
CPR does not help as much as most of us think.
CPR works best if:
• You are healthy.
• It can be given to you within a few minutes of when your heart or lungs stop working.
CPR does not work as well if:
• You have chronic health problems.
• You have an illness that can no longer be treated.
• You are older and weak.
If you are in the hospital and get CPR, you have a 17 percent chance of it working and leaving the hospital alive.
If you are older, weak, and living in a nursing home, CPR works less than 3 percent of the time.
What choice of CPR is best for me?
The first choice of CPR on the POAHC document is “conditional CPR”. This is most frequently chosen by adults who are in relatively good health. This choice indicates that you want CPR attempted unless at some point in the future your physician determines that CPR has no reasonable chance of success or it has a low chance of success and would inflict on you significant suffering, based on your medical condition at that time.
The second choice of CPR (full code) says that you want CPR attempted regardless of what your health status is at the time.
The third choice of CPR states that you do not want CPR attempted at all.
(*Note: Even if a person elects not to have CPR attempted, this does not mean that other measures to prolong life need to be limited, unless you state in your POAHC document that you want ‘comfort care’ only.)
The doctor that knows you best can help you make your decision about CPR, if you have questions. [Return to Top
13. How do I change the document if I want to make changes?
There are several types of changes that you might need to make. One type of change is to simply up date the contact information for your health care agents. I f you only want to change the phone numbers or address for one or more of your health care agents, you can type these on a separate sheet of paper and attach this to the front of you power of attorney for health care document. If your POAHC is already in your medical report, send this typed sheet to Gundersen Release of Information, 1900 South Ave. CB0-004, La Crosse, WI 54601.
If you wish to change the names of your agents or provide new instructions, then you can either create an addendum form that must be signed, witnessed, and dated like the original document or your can start over and do a new power of attorney for health care document. [Return to Top
14. Questions related to autopsy and organ donation.
Expressing your values about organ and tissue donation or autopsy is optional, but can be helpful to your family. The chance that either of these decisions will be faced is small. The important thing is simply to express your feelings or values about these matters so your family can more confidently respond to these questions should they arise. If the hospital requests an autopsy, there is no charge to the patient or the family and having an autopsy does not interfere with funeral plans. [Return to Top
15. When may I sign my POAHC for healthcare?
After you have completed filling out the power of attorney for health care document, you may sign the document. However, you MUST sign it in presence of two witnesses as described in the document and the dates of your signature and the signatures of the witness MUST be the same. [Return to Top]
16. When can my health care agent make my medical decisions?
Once you have signed, witnessed and dated your power of attorney for health care document it is a valid document. However, your health care agents typically cannot make any health care decisions for you until you have been determined to lack capacity to make your own health care decisions. In Wisconsin, incapacity is determined by either two physicians or a physician and a psychologist and in Iowa and Minnesota it is determined by one physician. [Return to Top
17. What should I do when I travel?
When you travel, it is helpful to either carry a wallet card that tells health professionals that you have a power of attorney for health care and how to obtain a copy from you local health care organization or you might carry a copy with you. The laws in most states now explicitly recognize the legality of documents created in accordance with statutes of other states. Since the most common way for a power of attorney for health care to be valid is by signing and witnessing by two people, following this process gives you the great assurance that your document will be effective in other places. [Return to Top
18. Does my family already have authority to make my decisions for me?
Many people assume that a spouse or adult children automatically have authority to make health care decisions when a family member becomes seriously ill. In Wisconsin there are no statutes or court decisions that support this process and it is only by customary practice that family are allowed to make such decisions. In many cases this common practice will be enough. The authority of the family to make decisions to admit a person to a nursing home or to stop medical treatment, however, does not exist or is very limited. The only way in Wisconsin that you can be assured that your family will have the authority they need to make your health care decisions should you become incapable is to legally appoint them as your health care agents in a power of attorney for health care. [Return to Top
19. Should I update my basic advance directive if I develop a serious, incurable illness?
While everyone should consider completing a power of attorney for health care, at some point more planning will be needed. For example, if an individual develops a serious, incurable illness that will get worse overtime, then it is important to review your plan and make it more specific. At some point, you will need to consider if your preferences and goals should be written as medical orders. This decision to have your new preferences about future medical care put into medical orders typically is needed when you absolutely do not want certain types of medical care. For example, when you can say that you would not want cardiopulmonary resuscitation (CPR) attempted if your heart stops or you do not want to return to the hospital for intensive care should you become very sick. If you feel that you have reached a point in a serious illness where you do not want certain types of medical treatments and you want these decisions to be expressed as medical orders, talk with your physician or call 608-775-9336 (1-800-362-9567, 59336) and ask for assistance in developing a plan more specific to your personal goals and stage of illness. [Return to Top