not be related to the patient by blood or marriage, entitled to a
part of the patient’s estate, or have a claim against the estate.
Once a patient becomes incapacitated, the third party must
consult with the physician. The physician will determine if the
patient is incapacitated, document the information, and file the
full healthcare power of attorney in the health record.
As with any document, there are some exceptions or specific
situations in which a healthcare power of attorney cannot make
treatment care decisions. For example, a third party cannot withhold comfort and care on behalf of the patient, make the decision
for an abortion, or commit a patient to a mental health facility.
A patient can grant anyone healthcare power of attorney except the patient’s provider, employee of the provider, residential
care provider, or employee. The person chosen should have a
clear understanding of the patient’s healthcare treatment preferences, which may or may not be spelled out within the document. A person can name more than one third party to fulfill
this role, and the second person has the same decision-making
rights as the first.
Healthcare powers of attorney generally do not expire but do
not extend past death unless otherwise documented. Time limits can be set, however, and if included should be a part of the
original document and not added at a later date. The healthcare
power of attorney becomes effective upon signature and is in
the possession of the third party. However, as long as the patient
is mentally capable, the third party cannot make a decision that
would override the patient’s.
A healthcare power of attorney can be revoked at any time by
the patient, as long as he or she is competent. A second healthcare power of attorney will override the first as long as the patient signs that the second document was created, signed, and
reviewed while being of sound mind. Once the provider has
been notified that a revocation exists, it should be recorded
within the patient’s health records.
Living Will
A living will allows a patient to express his or her wishes concerning life-sustaining procedures. It differs from a healthcare
power of attorney as it does not allow a patient to appoint a specific third party to carry out these wishes.
For example, a patient may choose to request no mechanical
ventilation support in the event of a life-sustaining injury. A living will is not expected to cover every situation that may occur.
Therefore, most states require both a living will and a healthcare
power of attorney to interpret a patient’s comprehensive healthcare wishes.
Do-Not-Resuscitate Orders
A DNR order is a specific request from the patient to not administer cardiopulmonary resuscitation (CPR) in the event that his
or her heart or breathing stops. A DNR is recorded as a physician order within a patient’s healthcare record. A patient’s liv-
Legal Document Definitions
Power of attorney for finances: allows a third party (proxy)
to act on behalf of a patient in financial and other matters.
The third party is allowed to perform extensive activities
such as writing checks, making investments, and buying or
selling property.
Healthcare power of attorney: a broadly scoped document that covers most healthcare decisions. It does not require the patient to be terminal or in an irreversible condition
before allowing for third-party medical decisions.
Durable power of attorney for healthcare: designates
a third party (healthcare proxy or agent) to make healthcare
decisions about a patient in the event of incapacitation.
Living will: allows patients to express their wishes concerning life-sustaining procedures. It differs from a healthcare power of attorney as it does not allow a patient to appoint a specific third party to carry out these wishes.
Do-not-resuscitate order: a specific request from the
patient to not administer cardiopulmonary resuscitation
(CPR) in the event that his or her heart or breathing stops.
ing will may or may not include a DNR request. A physician can
write a DNR order in the absence of a living will.
Advance Directives
Advance directive are documents that reflect a patient’s medical
care preferences. The word is plural because two primary documents are involved: the healthcare power of attorney and living
will. Together these documents can provide a patient’s clear and
concise medical treatment plan.
In order to inform patients of their rights to dictate their future care, Congress passed the Patient Self-Determination Act
in 1991, which mandates healthcare providers educate patients
about advance directives. Organizations are required to provide
written notice upon admission to the facility regarding patient
rights and policies regarding advance directives. These rights
include the right to facilitate the patient’s healthcare, the right
to accept or refuse treatment, and the right to execute advance
directives.
In addition, a facility must ask patients whether they have current advance directive documents and include both the inquiry
and forms (if available) within the health record. If a patient
does not have advance directives, the facility must offer education regarding these documents.
When these documents have been submitted to the provider
or healthcare facility, HIM professionals must ensure the health
record clearly indicates the existence of these documents and
that they are readily available to the healthcare professional. ¢
Lou Ann Wiedemann ( lou-ann.wiedemann@ahima.org) is director of professional practice resources at AHIMA.
