nently unconscious unless that person has specifically so stated in his or living will. In other words, in the absence of such a specific statement in your Living Will, you will have to be kept alive, perhaps indefinitely, through artificial and invasive forms of nutrition and hydration, even if you are permanently unconscious or in a terminal condition.

 

      What To Do? Your living will should be reviewed and updated as necessary so that you can specifically declare whether or not you intend for artificial or invasive forms of nutrition and hydration to be treated as any other form of life-sustaining treatment, which should be withheld or withdrawn if they will only serve to prolong the process of dying or maintain you in a state of permanent unconsciousness, or if you intend that such treatment should be withheld or withdrawn only under special conditions, such as your agent’s determination that such treatment would be excessively burdensome to you or would be disproportionate compared with the expected benefits of such treatment.

 

      Presumption to Exclude Advanced Stage Dementia.   Act 169 uses the terms “end-stage medical condition” and “permanently unconscious” as the conditions that will trigger the Living Will.  An “end-stage medical condition" is defined as an incurable and irreversible medical condition in an advanced state caused by injury, disease or physical illness that will, in the opinion of the attending physician to a reasonable degree of medical certainty, result in death despite the introduction or continuation of medical treatment. 

 

      What about advanced-stage dementia or advanced Alzheimer's disease?  While these are generally recognized by the medical community as incurable and irreversible medical conditions that should be covered by a Living Will, Act 169 does not allow them to trigger the Living Will’s instructions on the withholding or withdrawing of futile health care treatment, unless the patient’s Living Will specifically contains this instruction. As a result, patients who would not want to continue to receive life-sustaining treatment after they develop advanced-stage dementia or advanced Alzheimer's disease will have to be kept alive indefinitely if their Living Will does not specifically express their intentions. 

 

      What To Do?  Your living will should be reviewed and updated as necessary so that you can specifically declare whether or not you want a diagnosis of advanced-stage dementia or Alzheimer’s disease, or any other severe and incurable medical condition, to trigger your Living Will.

 

HEALTH CARE POWER OF ATTORNEY

 

      Act 169 expands and clarifies the authority of a health care agent to make any health care decision and to exercise any right regarding the principal's health care treatment that the principal himself or herself could have made and exercised, subject to any limitations set forth in the power of attorney itself.  The health care agent's authority may extend beyond the principal's death to make anatomical gifts, dispose of the remains, and consent to autopsies.  These powers will usually become effective only when the principal is determined to be incompetent.

 

      Important to Choose the Right Agents.  Because of the agent’s power to affect your health care treatment, it is very important that you appoint individuals you trust who will have both the time and the talent to effectively carry out their role.  Two issues that arise in designating agents are:

 

      1.  Multiple Agents vs. Single Agent.  This issue typically comes up when you want to name your children or someone other than your spouse to serve as your agent.