Last month the Georgia Advance Directive for Health Care Act — which replaced previous living wills and durable powers of attorney with a simpler document to help people express their wishes for their personal care and medical treatment — went into effect.
"This document is appropriate for every person who is taking a breath," said Deanna Richardson, MN, MPH, APRN-BC, manager and nurse practitioner with Piedmont Hospital's palliative care program.
The Georgia Advance Directive for Health Care form was hammered out during months of work by the Advanced Directives Study Roundtable — a diverse group of people from the academic, medical, legislative and legal communities, as well as state officials, ethics scholars and advocacy group members.
"I've done a lot of things in my career, but I'm probably most proud of my participation in getting this legislation passed. This dramatic change will be high on my achievement list. Normally, my work impacts one patient.
This change impacts millions of Georgians' lives for the better."
DEANNA RICHARDSON
Manager and nurse practitioner with Piedmont Hospital's palliative care program
Richardson was happy and honored to serve on the roundtable, because she knew how much a change was needed.
"Most people wait until the last moment, when they are in the hospital, to make their wishes about health care known," she said.
Richardson has seen many cases where there were no written instructions for care by a patient and differing opinions by family members.
"It can create a real dilemma for health care professionals and everyone," she said. "When there is a written document, there is much less room for argument."
The Terri Schiavo case created a paradigm shift in many people's thinking about end-of-life issues, Richardson said. Schiavo lapsed into a coma-like state in 1990, and her husband and parents battled in court for seven years over whether to keep her alive on a feeding tube.
Michael Schiavo argued that she would not want to live in a vegetative state; her parents said she would want to live because of her Catholic beliefs.
The courts sided with Michael Schiavo, and Terri Schiavo died in March 1995, days after her feeding tube was removed for the final time.
"It was the catalyst that caused people to start having conversations about their health care wishes."
Georgia's previous living will and durable power of attorney documents were hard to understand and cumbersome to execute.
"The attending physician of record, (who might not even be on site) had to sign it, as well as the patient and two witnesses," Richardson said.
The witnesses — one of whom had to be unrelated to the patient and neither of whom could be a health care provider — were required to watch the patient sign the documents.
"Most of the people in a hospital are health care providers. I would find myself pulling perfect strangers aside and explaining why I needed their help," Richardson said.
The new directive allows health care professionals who are not directly involved in a patient's care to serve as witnesses.
The new form is available at hospitals and nursing homes or can be downloaded at www.gabar.org by searching for the Georgia Advance Directive for Health Care Act. The form can be filled out, witnessed and changed at any time, as a person's situation or wishes change.
The directive has four parts. The first allows a person to name a health care agent and list the specifics of what that person can do. An agent, for example, would be allowed to agree to an autopsy, grant organ donation or dispose of the body, for example.
The second part lists all treatment preferences of the patient, such as whether he or she wants resuscitation or to be put on life-support systems. The third portion establishes guardianship, if it is needed. Once approved by the court, the guardian would make decisions for the patient if he or she be incapacitated or in a permanent state of unconsciousness. The final section includes the patient's signature and two witnesses, which makes the document effective. It does not need to be notarized.
"Our biggest concern was to make the document simple enough that the average person could pick it up, read it and understand his options," Richardson said.
Richardson's experience in palliative care gave her a unique perspective in helping draft the documents.
"It was types like me on the committee who kept telling the lawyers and legislators, 'guys, I'm not getting it. We're in a gray zone. Can we make it clearer?' "
The volunteer committee gathered information from every walk of life and kept revising the forms with the help of legislative advisers until they felt confident it would pass. "It flew through the House and Senate," Richardson said.
"I've done a lot of things in my career, but I'm probably most proud of my participation in getting this legislation passed. This dramatic change will be high on my achievement list," Richardson said. "Normally, my work impacts one patient. This change impacts millions of Georgians' lives for the better."