Advance care planning is important for individuals age 18 and older. Your loved ones will be left not knowing your wishes and may not be able to legally make health care decisions on your behalf without an advance directive to give authority for someone to make medical decisions on your behalf.

The law does not authorize an adult’s parent, spouse, child, etc., to make health care decisions on their behalf. Without an advance directive naming someone to make those decisions, a family may need to get the court involved to appoint a legal guardian to make these decisions. This can be costly, financially and emotionally to the family.

Advance care planning is a process that helps you think about your health care goals and values; consider health care choices that may have to be made in the future; talk about your choices with your health care provider and those close to you.

An advance directive is the legal document used to make a written plan.

By law, a health care facility cannot refuse care. However, some specialty providers, such as neurosurgeons, may require an advance directive on file due to the risk of a procedure.

Yes, it would be important to have an advance directive document on file before any procedure in case of complications.

Keep your advance directive in a safe spot. You can keep your original with your important papers. You also should make photocopies to share with your health care agent, children, primary care provider and health system in your electronic medical record.

It is important to have your advance directive in the medical record in the event of a medical crisis so the doctors treating you know your wishes and who can make your decisions. It is unfortunate, and not uncommon, that when these documents are needed, they cannot be found, they are completed inaccurately, or are not up to date.

If you have a My Marshfield Clinic account, you can attach your completed document to be routed to Health Information Management (HIM). The documentation must be saved on the device you are using to attach.

Once logged into your account, select Messaging – Inbox – Send a Message.

From there, select your name in the “on behalf of” section and enter “Legal Documents” from the dropdown in the “To” field. Add a free text subject or select a subject from the drop down and add your attachments (advance directive documentation). You are required to enter text into the Message field and tap Send.

You also have the option to email your completed advance directive to Health Information Management at mclhim.consents@marshfieldclinic.org. If you prefer to send via mail, you can mail your to Health Information Management, HM2, Marshfield Clinic Health System, 1000 North Oak Avenue, Marshfield, WI 54449, to be filed with Marshfield Clinic Health System.

Marshfield Clinic Health System patients will have access through their My Marshfield Clinic account or can request through Health Information Management, HM2, Marshfield Clinic Health System, 1000 North Oak Avenue, Marshfield, WI 54449 Fax: 715-389-0564 Email: himspec@marshfieldclinic.org.

A Living Will does not name another person to make health care decisions in another’s behalf. It provides direction regarding life sustaining procedures but is only effective if your condition is terminal or you are in a persistent vegetative state. A Power of Attorney for Healthcare (POA-HC) appoints someone to make health care decisions on your behalf. It is effective if you are determined to be incapacitated and can be reversed if you regain capacity. (Note: In Wisconsin, only a person’s legally authorized representative can provide informed consent to health care on behalf of another adult. Without a POA-HC, a guardian may need to be appointed by the court, which requires more time and money.)

Yes, a POA-HC is chosen by the patient, it is more private, has no court involvement, and has more flexibility and freedom in decision-making based on wishes expressed in the advance directive. A guardian is less private, and the court is involved in all aspects, including annual reports of your status.

Patients who have a legal guardian* have been declared incompetent** in a court and are not able to complete an advance directive once guardianship of that person has been established.
**Note incapacitated is the medical terminology and is determined by two medical providers (explained under “incapacitated” above). Incompetent is the legal terminology and is determined by a court.

A health care agent is the person you would need to name on your advance directive. This person can make health care decisions for you when you can’t make your own choices. An agent may be needed if the person is incapacitated or is nearing the end of their life.

You should choose a person who you trust with your medical care decisions. A health care agent must be at least 18 years old and of sound mind, but not: your health care provider, an employee of your health care provider, an employee of a health care facility in which you are a resident or patient, or a spouse/domestic partner of any of the above unless that person is also your relative.

Your health care agent should be someone you trust that is:
• Willing to accept the responsibility.
• Willing to talk with you about goals, values and preferences for medical treatment.
• Able to make decisions during difficult moments.
• Able to follow through on your wishes, even if they don’t agree with them.

Two doctors and/or health care professionals authorized under current state law need to examine/evaluate the patient to determine if the patient is capable of making health care decisions. If not, a statement of Incapacity will be signed and will be attached to the current POA-HC document.

A health care agent makes decisions based on the person’s wishes and values. An agent may make the following choices for the person:
• Decide on tests, surgery and medicine
• Choose the patient’s doctor(s)
• Choose the location(s) where the person may receive care
• Decide to stop treatment
• Decide whether to share the patient’s medical records

If you have no advance care plan, family, friends and your medical team will not have an understanding, or an appreciation of your individual wishes related to your current and future health care. More importantly, if you do not participate in any advance care planning, then you may not have had an opportunity to truly consider your own wishes. If you have no advance directive, your wishes regarding health care may not be known. More importantly, there will likely be no one who will have legal authority to make medical or health care decisions on your behalf without the court or legal system getting involved.

You can still write down the treatments you want or do not want. A health care agent can be a friend, a close neighbor or someone from work or church.

In Wisconsin, you must have your advance directive signed in front of two witnesses. You are unable to have it notarized. In other states, an advance directive can be signed in front of a notary public.

A witness must be at least 18 years old and not related by blood, marriage, domestic partnership or adoption to you. They also cannot be your health care agent or financially responsible for your health care or entitled to or have a claim against your estate. A witness cannot be your health care provider or an employee of your health care provider at time of signing. In Wisconsin, social workers and chaplains may serve as witnesses even if employed by the health care provider. Two witnesses are required to witness the principal’s signature. A notary is not required with two signatures in Wisconsin.

Advance directives should be reviewed with your health care professional frequently. These five “Ds” are important time periods to update your advance directive.
• Decade – At each 10-year birthday (i.e., 40, 50, 60, 70, 80, 90)
• Death – When there’s been a death in your family or support system.
• Diagnosis – If a serious medical problem arises for you or one of your named agents.
• Divorce – If your spouse was named as agent of your directive.
• Decline – If your or your agents’ health declines rapidly or if you lose functioning.

If you change your mind regarding some of your wishes, complete a new form. Once the advance directive document is signed and witnessed, it is considered legal and cannot be changed. A new document must be completed to add, change or remove health care agents, or any other changes to the document. The most current form on file will be used.

Each state may have different laws. You should check with your health care location to see if they have your advance directive on file.