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Correction to This Article
The Cash Flow column in the March 27 Business section used an incorrect acronym to refer to the Health Insurance Portability and Accountability Act of 1996. It should have referred to the law as HIPAA.
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It Takes More Than a Living Will

Taken together, these two documents constitute an "advance medical directive," and this is the package that everyone should have. Indeed, many states now offer forms combining them.

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For example, some attorneys recommend a separate HIPPA authorization to enable your agent to receive medical information about you. Your medical power of attorney becomes effective when you are incapacitated, but HIPPA, the Health Insurance Portability and Accountability Act of 1996, imposes tough privacy rules on doctors, raising the possibility that without special authorization your agent may not be able to obtain the information necessary to invoke the power of attorney.

Also, there are special instructions, such as a "do not resuscitate" (DNR) directive, that some people, such as those in the last stages of a terminal illness, may wish to include. "People should understand that a living will is not a DNR. If they want the DNR, they should get that," Cohn said.

Conceptually and mechanically, advance medical directives are fairly simple. Blank forms are readily available online, at hospitals and from state agencies. Many include organ donation forms, for those who wish to do that.

In general, it's a good idea to use a form for your state. And you should get it properly witnessed, usually by two disinterested people. State rules are usually available with the form or online, but you may want to check with an attorney if you have doubts.

Also, if you spend a lot of time in another state -- for example, at a vacation home -- an attorney can advise you on whether your home state's form is likely to be recognized in your vacation state, or whether you should execute one for the second state as well. Attorneys say this is becoming less and less of a problem as state laws grow more uniform, but there can still be gaps.

But simple as they may seem on their face, these forms involve difficult emotional and intellectual questions that individuals executing them need to deal with. Experts recommend great care in the choices you make.

First, your agent should be someone who understands your views on medical treatment, death and dying, and who you are confident will follow your wishes. Living wills tend to be worded broadly, and almost always need interpretation in specific circumstances. Your agent will be the person to whom medical caregivers will turn for guidance, and the agent will have to do his or her best to decide as you yourself would have.

Note: In most states, the law allows physicians and hospitals to refuse to follow your directive for reasons of conscience. Some attorneys say they've never found this to be a problem, while others say they have. To be safe, if you figure you'll be treated at a certain hospital, it won't hurt to chat with the administrator to see whether there are objections to what you have in mind.


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