It speaks for you when you cannot. It tells what treatments you do or do not want and who will make the health care decisions for you when you cannot.
An AD is signed by you when you are a competent adult naming someone you trust to make your health care decisions if you are incapacitated.
It is the inability to understand information or communicate health care decisions.
Anyone who is at least 18 years old and of sound mind, but not: your health care provider, an employee of your health care provider, an employee of a health care facility in which you are a resident or patient, or a spouse/ domestic partner of any of the above unless that person is also your relative.
Yes. It must be signed by the person in the presence of two witnesses at least 18 years old. At the time the document is signed, no witnesses may be:
Upon receiving a valid document, a health care facility or physician reviews the document to make sure it is valid. The document is then scanned into your electronic medical record. If you have been certified as incapacitated, that activation form is also placed in your medical record so that we can respect your stated desires consistent with applicable law.
No health care facility or provider may be criminally or civilly liable or charged with unprofessional conduct for:
No health care agent, unless the agent is the spouse or domestic partner of the principal, may be held personally liable for goods or services purchased or contracted for under a DPAHC. The medical cost liability would be the same as if the care was provided as a result of the person’s decision.
A health care agent, acting in good faith, does not incur criminal or civil liability for health care decisions made under a valid DPAHC.
The regular Durable Power of Attorney document is used for finances but does not include health care issues. (If the Durable Power of Attorney was completed prior to April 28, 1990, and includes health care decision-making ability, it is presumed to be valid.) The DPAHC addresses only those issues relating to health care.
If you sign a new DPAHC, the prior one is revoked. Notify your health care agent(s) and health care provider(s) orally or in writing that you revoked your DPAHC. If the agent is the person’s spouse or domestic partner, the DPAHC is automatically revoked upon divorce, annulment of the marriage or notice of termination of domestic partnership.
A Declaration to Physicians tells your doctor of your desires regarding life-sustaining procedures or a feeding tube if you were to develop an illness or injury that cannot be cured or were in a persistent vegetative state. A Declaration to Physicians may authorize the withholding or withdrawal of life-sustaining procedures or feeding tube when two physicians, one of whom is the attending physician, have personally examined and certified in writing that one has a terminal condition and is unable to understand or express health care choices, or is in a persistent vegetative state.
A Declaration to Physicians goes into effect if two physicians certify that you are terminally ill or in a persistent vegetative state and have lost the ability to make medical decisions. It only deals with the use or non-use of life-sustaining procedures or feeding tubes. A DPAHC is said to be activated if two physicians, or a physician and a psychologist, have personally examined you and certify that you are incapacitated and cannot make health care decisions. However, you do not have to be close to death or in a persistent vegetative state. The DPAHC allows another to speak for you and to make health care decisions for you that are not limited to just artificial life-sustaining procedures or feeding tubes. Your agent may also make decisions for you regarding nursing home or community-based residential facility placement and organ donation, among other things. The type of decisions your agent can make depends upon the authority you give when you complete the document.
It is not necessary to have both a Declaration to Physicians and a DPAHC. If you have both documents, make sure they do not conflict. If they do conflict, a health care provider will follow the instructions on the DPAHC rather than the instructions of the Declaration to Physicians (if the DPAHC is dated after December 11, 1991).
You may revoke or redo a Declaration to Physician or DPAHC at anytime.
Some health care providers and physicians may have policies or beliefs, which prohibit them from honoring certain ADs. Discuss your AD with your providers to make them aware of your wishes and to determine if they will honor it. If they will not, you may choose another provider.
You still receive medical care even if you do not have an AD. You may not receive the type of care and treatments you want if you could still make decisions for yourself. If you cannot speak for yourself and do not have an AD, a physician or health care institution may ask the courts to appoint a legal guardian who would then make decisions for you.
Keep your AD in a place where you and others can easily find it, but not in a safe deposit box. Make sure your family members or domestic partner, physician, health care provider, hospital and lawyer are aware that you have an AD and give each of them a copy of your document. It is ideal to have the document in your medical record.
Your physician or other health care provider, your attorney, the Pastoral Care dept. at HSHS St. Mary’s Hospital Medical Center at (920) 498-4282 or the Wisconsin Department of Health and Family Services at (608) 266-5863. This information is adapted from the Wisconsin Department of Health and Family Services.
Documents signed in another state on or after May 5, 2004, are valid and enforceable in Wisconsin if they were valid in accordance with the laws of that state. The document must authorize your agent to make the same decisions for you that a health care agent in a valid Wisconsin document could make for you.
St. Francis of Assisi