Care Instructions Including Living Wills
Although this is undoubtedly a truly sensitive subject, it must be addressed. All of us should review healthcare-related documents, including a living will, DNR, healthcare directive, and HIPAA release immediately.
You need to have signed current documents in place that reflect your desires. Your health directive and HIPAA release should list an agent who is able and willing to act. It is also a good idea to name several successors. If you have moved, your document is old, or if listed family or friends are not well, you should consider revising the document to name new people. At this challenging time, it is most important to address these documents. If you have elderly parents or loved ones, be sure they also have documents in place.
Be sure that you have printed copies of current documents or PDFs obtainable online as you go through hospital admissions.
There are several critical issues concerning healthcare-related documents that may require immediate revisions to your documents. These issues are specifically related to the current coronavirus pandemic.
You made need to modify HIPAA Releases, Living Wills, DNRs, and Health Care Directives for the Coronavirus. Before this time, if you were hospitalized and a medical decision had to be made, your agent would more than likely be in the hospital with you along with your documents prepared to act. Given the need for social isolation and quarantine, this may not be permitted, and this changes the way your health care directive or HIPAA documents can be used. It is likely the agent won’t be able to be there to sign documents and communicate decisions in person.
Language could be added to all healthcare-related documents authorizing your health care agent to give directions via telephone, FaceTime, Skype, or the many different types of communication. Your updated document should specifically allow medical providers to rely on and accept your agent’s instructions using these specific forms of communication along with decision-making powers. The documents should certainly hold harmless and indemnify all medical care providers from any liability for relying on these types of indirect means of communication by the agent to them as this is a unique situation and is not contemplated in many of the forms and documents in use.
Look at your current documents, and if they don’t state clearly that the above types of decision making are permitted, then most likely, it is not allowed. If you don’t have existing documents, you need to get them. Carefully read them and then see what they provide for communication and decision making. If they don’t address this vitally important matter, consider the sample language below.
Here’s a suggestion of what to review with an attorney, “I expressly authorize my Health Care Agent to make decisions through any available means of communication to my medical providers. This includes face-to-face, by telephone, through email, web conferences (including but not limited to such services such as Skype, Zoom, or FaceTime), or in any other manner reasonably appropriate under the circumstances. Further, I expressly hold harmless any medical provider for relying on such communications by my Health Care Agent of decisions and directions. The intended purpose of this provision is to foster the ability to make a decision by my Health Care Agent in remote or indirect manners that may be necessary or advisable given whatever circumstances accompany such decision making.”
Also, please review the language about Intubation in your documents. Intubation comprises inserting an endotracheal tube into the trachea to secure an airway and provide oxygen. This machine is called a ventilator and due to the nature of the coronavirus, this may be essential to treat you and keep you alive. Although many standard documents and forms include the absolute prohibition of Intubation, this could prove to be a death sentence if you or one of your loved ones comes down with the heinous coronavirus. If you end up hospitalized and the medical facility has to make the most difficult decisions of which patient gets to use the limited number of ventilators, and then finds documents have a mandate not to be put on a ventilator, then why would you be allocated a scarce one? Review your documents immediately and revise them if necessary.
Someone who has an underlying medical condition and is deemed old, sixty years old for the coronavirus, and they contract the virus would almost assuredly want to be intubated if that meant that they would survive. We would certainly want every medical step taken to preserve our life! Many people age sixty might be very likely to survive coronavirus but may have to be intubated. Read your documents if you have them and be sure that they say what you truly intend. If you don’t, get new documents drawn up which have more reasonable prescriptions for Intubation that won’t deny the care you might actually want.