Frequently Asked Questions About Alabama Advance Directives For Health Care

Alabama Living Wills and Health Care Proxy Designations

What Is An Advance Directive in Alabama?

An Advance Directive is a way to protect your legal right to direct the kind of medical treatment you receive in certain situations. It gives your healthcare providers guidance about the kinds of things you would and would not want to happen if you were to become permanently unconscious or  terminally ill or injured.  By recording your wishes ahead of time you can ensure that they are followed by your doctors and clear to your loved ones.

An Advance Directive in Alabama typically contains two sections: a living will and a health care proxy designation.  Your living will records your wishes with regard to medical treatment, while a health care proxy designation appoints someone to speak on your behalf with regard to your medical care if you are unable to speak for  yourself.

Who Can Sign an Advance Directive in Alabama?

Any competent adult.

When Does My Advance Directive Become Effective?

Your advance directive only becomes effective when you are no longer able to make informed medical decisions for  yourself.

Who Decides If I Am “Terminally Ill” or “Permanently Unconscious”?

Your advance directive becomes effective when:

(1) Your attending physician determines that you areno longer able to understand, appreciate, and direct your medical treatment;  and (2) two physicians, one of whom is your attending physician, and one of whom is qualified and experienced in making such diagnosis, have personally examined you and have diagnosed and documented in your medical record that you have either a terminal illness or injury or are in a state of permanent unconsciousness.

Terminally ill or injured is when your doctor and another doctor decide that you have a condition that cannot be cured and that you will likely die in the near future from this condition.

Permanent unconsciousness is when your doctor and another doctor agree that within a reasonable degree of medical certainty you can no longer think, feel anything, knowingly move, or be aware of being alive. They believe this condition will last indefinitely without hope for improvement and have watched you long enough to make that decision.

What Is Life-Sustaining Treatment?

Life sustaining treatment–Life sustaining treatment includes drugs, machines, or medical procedures that would keep you alive but would not cure you.  Even if you choose not to have life sustaining treatment you will still get medicines and treatments that ease your  pain and keep you comfortable.

What Is Artificially Provided Food and Hydration?

Artificially provided food and hydration (Food and water through a tube or an IV).  If you are terminally ill or injured you may need to be given food and water through a tube or an IV to keep you alive if you can no longer chew or swallow on your own or with someone helping you.

If I Have an Advance Directive Can I Still Receive Pain Medication?

You can receive pain medication and palliative care (medical care to make you more comfortable) even if you have indicated in your advance directive that you do not want life-sustaining treatment.

Do I Have to Have an Advance Directive in Alabama?

You are not required to have one, but federal law requires hospitals to ask you when you are admitted whether you have an advance directive or if you would like one. The hospital cannot make you sign an advance directive, but they will give you the option to create one if you do not already have one.

If The Hospital is Going to Offer Me an Advance Directive Why Would I Hire a Lawyer to Prepare One?

The decisions you make in an advance directive are important and the process of considering your options and signing a directive can be complicated.  It’s a good idea to think about your advance directive before you need it and while you are in good health so that you have time to think about your choices and aren’t trying to make such emotional decisions under the stress of being hospitalized.

Is an Advance Directive the Same as a Do Not Resuscitate Order (DNR)?

No.  A Do Not Resuscitate Order is a document you may sign after consultation with your doctor which orders that you not receive cardiopulmonary resuscitation (CPR) in the event your heart stops beating.  A DNR is signed by both you and your doctor while your advance directive is signed only by you.

Where Should I Keep My Advance Directive?

Keep the original safe but accessible, maybe in a desk with your other important papers.  Tell your loved ones and your health care proxies (as well as any alternates) where you stored the original.  Do not store your advance directive in a safe deposit box because it will be difficult for anyone besides you to access it – and if you need your directive chances are you will not be able to go to the bank.  Remember that copies work just as well as the original, so you can store copies in a few alternate locations such as the glovebox of your car or at your office.

You should give a copy to each doctor you visit regularly and ask them to keep the directive in your medical record. Give a copy to anyone you name as a health care proxy or alternate proxy in your directive. You may consider giving a copy to anyone else you think will make the advance directive’s existence known to your doctor if you are unable to do so yourself.  For example, you may give a copy to a close neighbor or a member of your clergy.  Ask your lawyer whether he or she will keep a copy of your signed directive, where it will be stored, and how long it will be kept.

Finally, you may consider keeping a card in  your wallet or purse with your proxy’s name and phone number and noting where you keep your original directive.

How Will My Doctor Know That I Have An Advance Directive?

When you are admitted to the hospital someone should ask if you have an advance directive, at which time you should give them a copy or ask your health care proxy or a loved one to bring it to you.  It’s also a good idea to give a copy of your directive to any doctors you see regularly so that they can keep it in your medical record.  If you are unable to speak for yourself your health care proxy or someone else close to you should let your doctor know that you have an advance directive.

How Can I Make Sure My Advance Directive Wishes Are Followed?

A hospital must follow your wishes as stated in your directive. If they will not follow your directive then they must get you to a hospital that will follow your wishes as stated in your directive.

You should make sure that your directive is available when you need it by giving copies of your directive to any doctors you see regularly, to your proxies and alternate proxies, and by keeping the original in a secure but accessible place.

However, the most important step you can take towards making sure your wishes are followed is to have open and honest conversations with your family, your doctors, and your health care proxies about your wishes.

Will My Alabama Advance Directive Be Honored In Another State?

Maybe.  Your Alabama advance directive may meet the requirements for a valid advance directive in other states.  If you spend a lot of time in another state you may consider signing an advance directive for that state in addition to your Alabama advance directive.

Will My Out-of-State Advance Directive Be Honored In Alabama?

Maybe.  You should speak to an Alabama estate planning attorney about whether your out of state advance directive meets the requirements of an Alabama advance directive.

Who Should Be My Health Care Proxy?

You should choose someone you trust, such as a spouse, family member, or close friend to be your proxy. You should choose someone who understands your wishes and is comfortable communicating those wishes to your medical providers.

Only competent adults can be  health care proxies in Alabama, so you cannot appoint your minor child to be your proxy.  Your health care provider cannot serve as your proxy either.

Whomever you choose, you should speak with that person about your wishes and make sure the person is willing to serve as your proxy. If they do not think they can follow your wishes you should choose someone else.

Does The Person I Appoint As My Proxy Have to Accept?

No.  If your proxy chooses to accept the designation then he or she will sign a form attached to your advance directive.  If they do not wish to accept the appointment then they simply do not sign the form.

Does My Health Care Proxy Have to Pay for My Medical Treatment?

No.  Being a health care proxy does not make a person responsible for someone else’s medical treatment.

Can My Health Care Proxy Make Decisions That Conflict With My Wishes as Stated in My Advance Directive?

You have three options when you sign a proxy designation:

(1) you can direct that your proxy must follow only your wishes as stated in your advance directive;

(2) you can say that you want your proxy to follow the wishes as stated in your advance directive AND be able to make decisions about  things you have not covered in your advance directive; or

(3) you can give your proxy permission to make the final decisions about your care, even if that means doing something different from what  you chose in your advance directive.

Unless you specify otherwise, the default rule in Alabama is that your proxy’s decisions will take precedence over your wishes as stated in the living will portion of your advance directive.  This part of the form can be confusing, but an experienced attorney can walk you through it to make sure you choose the option that most closely aligns with your wishes.

I Have Named My Spouse as My Health Care Proxy.  What Happens If We Get Divorced?

In Alabama your divorce probably revokes your appointment of your ex-spouse as your health care proxy. Your divorce decree may provide differently, though, so you should speak with an attorney about your specific situation.

I Already Have a Power of Attorney.  Do I Still Need an Advance Directive?

Yes. A power of attorney for your property will have no effect on your health care.  You may have a separate health care power of attorney which may include a living will and/or a health care proxy designation.  You should speak with your attorney to make sure that your health care power of attorney covers the situations you are concerned about.

How Often Should I Review My Advance Directive?

It’s a good idea to review your advance directive every time you review your will.  Consider reviewing your entire estate plan, including your health care directive, at least once a year and think about whether your wishes have changed.  You may need to sign a new advance directive if your proxy or alternate proxy dies or becomes incompetent, if your end-of-life wishes change, or if the law in your state regarding health care directives changes.

What If I Change My Mind?

You can change your mind at any time after you sign your directive as long as you are competent.   You can terminate your advance directive by signing a new one (in which case it’s a good idea to destroy all copies of your previous version).  You can also revoke your directive by tearing it up and telling an adult your wishes and asking him to write them down for you.

What If I Am Pregnant?

Your advance directive has no effect during your pregnancy.

Who Makes My Healthcare Decisions For Me If I Do Not Have an Advance Directive?

In Alabama the following people in this order of priority can make decisions about your healthcare if you become unable to make decisions for yourself and do not have an advance directive:

  1. A court-appointed guardian who has been granted the specific power to make end-of-life health care decisions for you;
  2. Your spouse;
  3. Your adult child;
  4. Your parent;
  5. Your adult sibling;
  6. Your adult relative of the next closest degree of kinship;
  7. If you have no adult relatives (or if they cannot be found), then a committee will be created that includes your treating physician and the ethics committee of the facility or hospital you are in.

Why Should I Sign an Advance Directive?

The most common reasons to sign an advance directive are to have control of your end-of-life treatment and to remove from your loved ones the burden of making difficult end-of-life decisions.

How Long Will My Advance Directive Last?

Your Advance Directive does not have an expiration date, so in general it will last until you revoke it.

Are you ready to sign an Advance Directive?  Call us today at 205-553-5353 to get started.