Guidelines dictate structure of living wills

By NAOMI SNYDER
Scripps Howard News Service

To help people receive the care they want as their lives are ending, states recognize instructions such as "living wills" and allow people to designate "proxies" to speak for them.

Living wills describe what medical treatment someone wants and doesn't want. A health care proxy (sometimes called a durable power of attorney for health care) identifies a person who can make treatment decisions if the patient can't. These documents can be revised or revoked at any time.

Copies should be given to each physician and included in the patient's chart. They should also be given to family members and to proxies.

Each state has its own name for these forms, which are often called "advance directives." States also have different requirements for making the documents legal. In some cases individuals can craft their own living wills or use the forms and follow directions available free from state agencies or state area agencies on aging. Forms are also available from Choice in Dying, a Washington-based nonprofit organization. The group charges about $5 for state specific forms and information. Choice in Dying is reachable at 800-989-9455.

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Below is a list, based on information provided by Choice in Dying, of what these directives are called in each state and various requirements for witnesses and notarization. (Even in states where witnesses are not specifically required, it's a good idea to have witnesses sign these documents.)

• Alabama: Advance directive for health care (both living will and health care proxy are included on form) needs two witnesses. Not valid if pregnant.

• Alaska: Declaration (living will) needs no witnesses. Health care proxy needs two witnesses but allows only general medical decisions to be made.

• Arizona: Living will needs a witness and notary. Health care power of attorney (proxy) needs a witness and a notary.

• Arkansas: Declaration (both living will and health care proxy are included on form) needs two witnesses. Not valid if pregnant.

• California: Declaration (living will) needs two witnesses and not valid if pregnant. Durable power of attorney for health care (proxy) needs two witnesses or a notary.

• Colorado: Declaration as to medical or surgical treatment (living will) needs two witnesses and not valid if pregnant. Medical durable power of attorney for health care (proxy) needs no witnesses nor notary.

• Connecticut: Health care instructions (contains both living will and health care proxy) needs two witnesses, whose signatures should be notarized. Not valid if pregnant. Appointment of attorney-in-fact for health care decisions (proxy) must be notarized.

• Delaware: Advance directive (contains both living will and health care proxy on form) needs two witnesses.

• District of Columbia: Declaration (living will) needs two witnesses. Power of attorney for health care (proxy) needs two witnesses.

• Florida: Living will needs two witnesses. Designation of health care surrogate (proxy) needs two witnesses.

• Georgia: Living will needs two witnesses. Not valid if pregnant. Power of attorney (proxy) needs two witnesses.

• Hawaii: Declaration (living will) needs two witnesses and a notary. Not valid if pregnant. Durable power of attorney for health care decisions (proxy) needs two witnesses and a notary.

• Idaho: Living will needs two witnesses. Not valid if pregnant. Durable power of attorney for health care (proxy) needs two witnesses or a notary public.

• Illinois: Declaration (living will) needs two witnesses. Not valid if pregnant. Power of attorney for health care (proxy) needs one witness.

• Indiana: Living will, declaration A or B, needs two witnesses. Not valid if pregnant. Declaration B says you want all life-prolonging procedures. Power of attorney for health care decisions and appointment of health care representative (proxy) needs a notary.

• Iowa: Declaration (living will) needs two witnesses or notary. Not valid if pregnant. Power of attorney for health care (proxy) needs two witnesses or notary.

• Kansas: Declaration (living will) needs two witnesses or a notary.

• Kentucky: Advance directive, section 2 (living will), needs two witnesses or notary. Not valid if pregnant. Section 1 (proxy) needs two witnesses.

• Louisiana: Declaration (both living will and health care proxy included on same form) needs two witnesses.

• Maine: Advance directive, Section II (living will), requires two witnesses. Section I (proxy) needs two witnesses.

• Maryland: Advance medical directive health care instructions (living will) requires two witnesses. Appointment of health care agent (proxy) needs two witnesses.

• Massachusetts: The state has no living will. Health care proxy needs two witnesses.

• Michigan: The state has no living will. Designation of patient advocate for health care (proxy) needs two witnesses.

• Minnesota: Health care living will needs a notary or two witnesses. May not be valid if pregnant. Durable power of attorney for health care (proxy) needs two witnesses or a notary.

• Mississippi: Advance health care directive (living will and health care proxy included on same form) needs a notary or two witnesses.

• Missouri: Declaration (living will) needs two witnesses. Not valid if pregnant. Durable power of attorney for health care (proxy) needs a notary or two witnesses.

• Montana: Declaration (living will) needs two witnesses.

• Nebraska: Declaration (living will) needs two witnesses or a notary.

• Nevada: Declaration (living will) needs two witnesses. Durable power of attorney for health care decisions (proxy) needs a notary or two witnesses.

• New Hampshire: Declaration (living will) needs a notary or a justice of the peace and two witnesses. Durable power of attorney for health care (healthy care proxy) needs a notary public or justice of the peace or two witnesses.

• New Jersey: Instruction directive (living will) needs two witnesses or a notary public or to be signed in front of a lawyer. Appointment of a health care representative (proxy) needs two witnesses or a notary or to be signed in front of a lawyer.

• New Mexico: Instructions for health care (living will) requires no witnesses. Power of attorney for health care (proxy) requires no witnesses.

• New York: Living will requires no witnesses, although they are recommended. Health care proxy needs two witnesses.

• North Carolina: Declaration of desire for a natural death (living will) needs two witnesses and a notary public. Health care power of attorney (proxy) needs two witnesses and a notary.

• North Dakota: Declaration (living will) needs two witnesses. Not valid if pregnant. Durable power of attorney for health care (proxy) needs two witnesses.

• Ohio: Living will needs a notary or two witnesses. Not valid if pregnant unless doctors say pregnancy won't result in a live birth. Durable power of attorney for health care (proxy) needs a notary or two witnesses.

• Oklahoma: Living will needs two witnesses. Not valid if pregnant. Appointment of health care proxy needs two witnesses.

• Oregon: Health care instruction (living will) needs two witnesses. Health care representative appointment (proxy) needs two witnesses.

• Pennsylvania: Declaration (living will) needs two witnesses. Not valid if pregnant. Appointment of a surrogate decision maker (proxy) is part of the declaration.

• Rhode Island: Declaration (living will) needs two witnesses. Not honored for pregnant women if fetus could develop enough for a live birth. Durable power of attorney for health care (proxy) needs two witnesses.

• South Carolina: Declaration of desire for a natural death (living will) requires two witnesses plus a notary. Health care power of attorney requires two witnesses.

• South Dakota: Living will declaration requires two witnesses. Not valid if pregnant. Durable power of attorney for health care (proxy) needs two witnesses or a notary.

• Tennessee: Living will requires two witnesses. Durable power of attorney for health care (proxy) needs two witnesses. A notary is optional.

• Texas: Directive to physicians (living will) needs two witnesses. Not valid if pregnant. Durable power of attorney for health care (proxy) requires two witnesses.

• Utah: Utah directive to physicians and providers of medical services (living will) requires two witnesses. Not valid if pregnant. Utah special power of attorney (proxy) needs notary.

• Vermont: Terminal care document (living will) needs two witnesses. Durable power of attorney for health care (proxy) requires two witnesses.

• Virginia: Advance medical directive (both living will and health care proxy) requires two witnesses.

• Washington: Health care directive (living will) requires two witnesses. Not valid if pregnant. Durable power of attorney for health care (proxy) requires no witnesses, although they are recommended.

• West Virginia: Living will requires two witnesses and a notary. Medical power of attorney for health care (proxy) also requires two witnesses and a notary.

• Wisconsin: Declaration to physicians (living will) needs two witnesses. Not valid if pregnant. Power of attorney for health care (proxy) requires two witnesses.

• Wyoming: Declaration (living will) requires two witnesses. Not valid if pregnant. Durable power of attorney for health care (proxy) requires two witnesses and a notary.

Exceptions:

• Some states also require an ombudsman to sign the form if the patient is in a hospital or health care facility. That's to protect the patient from overbearing relatives.

• Most states won't let a pregnant woman be taken off life support. Other states don't address the issue with legislation. Some allow women to say on their living wills that they don't want life support if pregnant (Arizona, Maryland, New Jersey). Four states allow a health care proxy to withdraw life support if the patient is pregnant (Florida, Maryland, New Jersey and Wisconsin).

(Naomi Snyder is a reporter at The Anderson Independent in South Carolina.)