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Advanced Planning for Healthcare Decisions

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Durable Power of Attorney for Healthcare Decisions

Living Will

Physician's Order for Life Sustaining Treatment and Do Not Resuscitate Order

Secretary of States’ Living Will Lockbox

 

Durable Power of Attorney for Healthcare Decisions

A Power of Attorney is a written document that you sign in which you authorize another person to act as your agent to make healthcare decisions for you. 

There may be circumstances when you are hospitalized, but are not terminally ill, and unable to make your own decisions.  In order for a power of attorney to be valid if you become disabled, you must create what is known as a “durable” power of attorney.  A durable power of attorney states that it will be valid even if you become disabled.  If it does not contain that language, your agent will not be able to use the power of attorney if you become disabled.

You can appoint someone to make healthcare decisions for you in a Durable Power of Attorney for Healthcare Decisions (DPAHD).  An advantage of a DPAHD is that it may prevent the need for a formal guardianship.  If you do not have a DPAHD and become unable to make your own decisions, someone may have to go to court to have you declared incompetent to be able to make decisions for you.  Such a process is costly, time consuming and burdensome. 

A DPAHD only becomes effective immediately, unless you state otherwise.  However, so long as you can give informed consent, you can make your own medical decisions.  

Please note, you must execute (or sign) the DPAHD before you are mentally incapacitated because it will not be valid unless you understand the nature and significance of it.  

The DPAHD only lasts as long as you are living.  Therefore, when you die, the DPAHD dies with you.  You can also terminate it at any time by revoking it or by executing a new one.

Your Power of Attorney for Healthcare can include a living will or advanced healthcare directive, discussed below.   

The 2015 Legislature recently created a special Healthcare Power of Attorney Form for adults with intellectual disabilities.  This form uses language meant to be easily understood by those adults with intellectual disabilities.  The form will be found in Nevada Revised Statute 162A.

 

Living Will

A Living Will, or advanced healthcare directive, is a declaration directing your physician to withhold or withdraw life-sustaining treatment if you have an incurable or irreversible condition.  It will only go into effect if you are unable to communicate your desires.  For example, if you are in a coma.

One common question asked regarding a Living Will is whether or not a doctor is allowed to provide any sort of pain relief or other comfort measures if such a document is executed.  Nevada law specifically provides that even though you sign a Living Will, the doctor or other provider of health care of the responsibility will give you pain medication and comfort measures.

In order to sign a living will, you must be of sound mind and eighteen years or older.  The Living Will must be signed by the creator and either attested to by two competent witnesses or a notary public.

A Living Will is different than a DPAHD.  The Living Will is a limited document because it only covers the medical circumstances mentioned and does not designate a decision maker for the creator. 

The 2015 Legislature created a form for end-of –life decision for adults with intellectual disabilities.  This form explains those decisions in an easy format so the adult with intellectual disabilities can understand what they are signing.

 

 Physician's Order for Life Sustaining Treatment (POLST) and Do Not Resuscitate Order (DNR)

A POLST is a legal document containing a physician’s order about medical interventions for the very frail elderly or those near the end of a progressive or terminal illness. The document expresses a patient’s wishes about very specific medical interventions that the patient may or may not desire.  For example, the POLST can specify whether ornot the patient wants CPR, feeding tubes, antibiotics, etc.  

The POLST form must be signed and dated by your doctor and by you or your legal representative. It is important that you make the decisions on a POLST in conjunction with your medical provider. 

The POLST should remain with the patient wherever they receive treatment.  If at home, the patient can keep the POST on their refrigerator or next to their bed, locations emergency responders are trained to look. 

The POLST can be used in conjunction with other legal documents such as DPAHD or Living Will; however, if there is a conflict among the documents, the POLST will govern. You can obtain a POLST form at http://health.nv.gov/EMS_Forms_DNR-POLST.htm.

Patients who are terminally ill may also qualify to obtain a Do Not Resuscitate Identification (DNR), which instructs pre-hospital emergency medical services personnel to withhold life resuscitating treatment in the event of cardiac or respiratory arrest.

To obtain a DNR, patients must fill out an application with the State provide a certification from their physician that they are terminally ill and otherwise meet the requirements.  The application is available at

http://health.nv.gov/EMS_Forms_DNR-POLST.htm.

These patients may be able to obtain bracelet or medallion to identify their DNR status.

 

Secretary of States’ Living Will Lockbox

A DPAHD, Living Will, or POLST provides very specific instructions for end-of-life care and is an opportunity to tell health care professionals and family members what you want as far as life sustaining or other treatment.  When healthcare professionals and others do not have access to such a document even though you have created one, they will not know your wishes in an emergency.

The Living Will Lockbox is a secure, virtual lock box in which Nevadans can file certain directives, including living wills, powers of attorney, and “do not resuscitate” (DNR) orders for access by designated health care professionals, and family when medical treatment decisions must be made.

There is no cost to file with the Lockbox.

Once you have a directive document, you can register it with the Lockbox online at www.livingwilllockbox.com or by mail at 101 N. Carson Street, Suite 3, Carson City, NV 89701.

Seven to ten days after filing your directive with the Lockbox, you will receive a letter confirming that the documents have been securely filed.  You will also receive a registration number on a wallet-size card and instructions for accessing the Lockbox, viewing the documents and making changes

Lock Box Brochure