how to decide who decides when i...how to decide who decides when i can’t decide decision making...
TRANSCRIPT
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How to Decide Who Decides When I Can’t Decide
Decision Making Options in Virginia
Dana W. Traynham
Senior Staff Attorney
disAbility Law Center of Virginia
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Vocabulary
• Capacity
• Advance Directive
• Power of Attorney
• Living Will
• Medical Directive
• Psychiatric Advance Directive
• Integrated Advance Directive
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Capacity
• The ability to:
• Take in information;
• Make an informed decision; and
• Communicate your decision.
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CAPACITY IS PRESUMED!
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Capacity is fluid• Time and circumstance
• Different levels needed
• Capacity needed for an advance directive?
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Levels of Capacity
• Must specify whether person lacks capacity to make:
• a particular health care decision
• a specified set of health care decisions
• all health care decisions
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Decision Makers
• ME
– Advance Directive
• Family
– Health Care Decisions Act
• Authorized Representative
– DBHDS
• Guardian
– Court Order
• Judge
– Court Order
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Advance Directives
• Instructions about end of life care: Living Will
• Naming an alternate decision maker: Power of Attorney
• Medical decisions other than end of life: Medical Directive
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Living Will
• Used only for end of life decisions.
• Specifies whether you want extraordinary measures or only comfort measures when you are terminally ill.
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Power of Attorney
• Types:
• Health Care (including MH)
• Financial
• Education
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Power of Attorney
• Things to consider when choosing an agent:
• Complete trust
• Willingness
• Availability
• Alternate or co-agent
• Beliefs and values
• Conflict of interest
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Powers of Agent
• Specific or general
• Limitations• End of life decisions?
• Visitation?
• Organ or tissue donation?
• Admission to psychiatric facility?
• Treatment over protest?
• Medical research?
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Medical Directives
• Expands medical directives to all medical care, not just end of life.
• Includes psychiatric medical directive.
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Choices• Alternatives to inpatient treatment • Facility • Physicians• Medications• ECT• Emergency interventions • Experimental studies; drug trials• Notifications and visitors• Other
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Signing
• No attorney necessary but is recommended.
• Two witnesses
• Notary is optional in Virginia but is recommended.
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Copies • Provide copies to the following:
• Your agent
• Your doctors
• Your local hospital
• State Registry
• Family members and others
• Keep track of who received copies.
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Revoking
• An Advance Directive is easy to revoke• Prior AD is automatically revoked when you write
a new one. • Tear up all copies.• Notify everyone who received a copy.• Oral v. written revocation.• “understand the nature and consequences of your
action.”
• Revocation to Registry
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But I haven’t done any of these things….
• Health Care Decisions Act
• Authorized representative
• Court-ordered treatment
• Guardianship
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Health Care Decisions Act
• Hierarchy of Alternate decision makers:
• Guardian/Agent in POA
• Spouse
• Adult child
• Parent
• Adult sibling
• Blood relative in descending order of relationship
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Guardianship
• Court decides capacity.
• Court order
• Often confused with Power of Attorney
• Limited or complete
• “Conservator” is appointed by court to make financial decisions
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Guardianship
• Last resort because:
• It takes away basic rights.
• It is the most restrictive choice.
• There is stigma and humiliation involved when a person is declared incompetent.
• It is expensive.
• It is often unnecessary.
• It is usually permanent.
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Guardianship
• Once declared incompetent, you lose the right to:
• Make treatment decisions
• Decide where you live
• Marry and divorce
• Vote
• Enter contracts
• Make a will or Advance Directive
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Guardianship
• Once declared incompetent, you lose the right to:
• Revoke a will
• Drive
• Possess a firearm
• Buy, sell or rent property
• Decide how your money is spent (conservatorship)
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Is Guardianship Always a Bad Thing?
• No
• Guardianship may be necessary in some situations.
• For a person who has never had capacity and will probably never gain capacity.
• For a person who is facing a major decision for which he lacks capacity (limited guardianship should always be considered).
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Why Alternatives?
• Inexpensive
• Easy to revoke or change
• YOU make the decisions
• Attorney usually not necessary
• Simple (“legalese” not necessary!)
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Resources
• disAbility Law Center of Virginia (dLCV)
– can provide guidance to callers and direct assistance if the case falls within our current objectives
– http://dlcv.org/supported-decision-making/
• www.virginiaadvancedirectives.org
• www.connectvirginia.org/adr/
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One Final Thing…
CAPACITY
IS
PRESUMED!!
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For more information:
disAbility Law Center of Virginia1512 Willow Lawn Drive, Suite 100
Richmond, Virginia 23230Toll-Free: 800-552-3962 (voice and TTY)
804-225-2042 (voice and TTY)E-Mail: [email protected]: www.dlcv.org