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Oregon Advance Directive | Medical POA & Living Will

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Oregon Advance Directive (Medical POA & Living Will) allows an individual residing in Oregon to appoint a health care agent, provide specific treatment preferences directly to attending medical personnel, or both. Once this paperwork is executed, it will become active if the principal is in a severe medical event where he or she is unable to communicate and decisions on treatments need to be made and applied. Essentially, the principal issuing this document will be able to fully convey his or her preferences in various scenarios on paper to the parties he or she considers relevant.  This precautionary measure to ensure one’s expectations are met when they suffer a traumatic medical event or succumb to a disease. The principal will only have to fill out the parts of this document that he or she wishes to use, although it is recommended to give some careful thought before filling out and seek a consultation with both the agent and relevant health care entities.

Definition – ORS 127.505(2)

LawsORS Chapter 127

Durable (Financial) Power of Attorney – Allows an individual to appoint an agent to care for their finances.

Signing Requirements (§ 127.515(2)(b)) – Two (2) witnesses or a notary public.

How to Write

Download: Adobe PDF, Microsoft Word (.docx) or Open Document Text (.odt)

1 – Obtain Your copy Of The Oregon Advance Directive

The above text links, displayed in blue font, allow a download of the previewed document and provide a choice of its format. The “Adobe PDF,” “Microsoft Word (.docx),” or “Open Document Text (.odt)” formats can all be opened and downloaded using these links or the similarly designated buttons. Once you have obtained your copy, open it then read the introduction. This content will contain vital information.

2 – Identify Yourself As the Issuer Of This Directive

You must solidify your identity so this paperwork will properly function in the future. Thus, find the section titled “I. About Me.” Here you will need to supply your full “Name” and “Date Of Birth” on the first two empty lines. Each will bear an appropriate label to guide you.     

The next four spaces are named after components of a standard address. Your residential address (as it appears on your paperwork) should be produced to these lines (“Street Address,” “City,” “State,” and “Zip Code”). After presenting your mailing address above, supply your “E-Mail” address on the next available line.        The “Telephone Number(s)” where you can be reliably reached for a live conversation must be reported in the next area of this section. The blank lines “Home,” “Work,” and “Cell” have been placed to allow an organized presentation of this information.     

 

3 – Name Your Oregon Health Care Representative

You must produce similar content pertaining to the individual who will be designated with the principal power to make health care decisions on your behalf when necessary. The full “Name” of this person should be placed on the first available line in the “II. My Health Care Representative” section along with the “Relationship” this person holds with you on the adjacent line.     

Next, you must document the address of the Health Care Representative that can be verified through the credentials of a federal or state I.D (i.e. a driver’s license). This process will be similar to the one above in that you will need to enter each part of this address on a line devoted strictly to its presentation. Thus, fill in the lines labeled “Street Address” through “Zip Code” with material defining your Health Care Representative’s address then supply his or her current “E-Mail” on the last line before the next part of this article.                                        Additionally, the Health Care Representative’s “Home,” “Work,” and “Cell” phone numbers will need to be provided so that he or she can be reached in a relatively quick fashion if necessary. The blank lines bearing these labels will expect these entries. It is strongly recommended that your Health Care Agent has at least one of these types of telephone numbers where he or she is accessible.          The section “A.) First Alternate Health Care Representative” is set as a failsafe in case the Health Care Representative is unavailable, unable, or no longer approved to represent you. This section places a runner up to the Health Care Representative role and the person you name here will have the powers you give your Representative automatically transferred to him or her if the Health Care Representative role becomes vacant. You will need to report this person’s “Name,” “Relationship,” and contact information (address, “E-Mail,” “Telephone Numbers”).                        Section “B.) Second Alternate Health Care Representative” fulfills a similar purpose as the previous one. This precautionary section will allow you to name an individual to assume the Health Care Representative role should both the parties we named above become indisposed, no longer able to fulfill this role for any reason, or had this power revoked (by you). This requires a report on the identity, residential address, and contact information produced on the lines with the proper designations.           

 

4 – Provide Instructions To Your Representative

The scope of your Health Care Representative’s principal powers can only be defined by you. In article “III. Instructions To My Health Care Representative,” the first step in this process, you must initial one of the three statements on display. It will be assumed by anyone reviewing this document that the statement on the right of your initials will be an accurate representation of the level of principal powers you intend to grant. Initial the first blank line if you require your Health Care Representative to follow the contents of this document literally (as they are reported), initial the second line if these instructions are meant only as a guide of preferences allowing the Health Care Representative some freedom in his or her use of principal power, or you may initial the third statement (“Other Instructions”) and specifically define the level of authority you wish to grant. In the example below, your Health Care Representative will only use this document as a basic guideline on what decisions you may make if you were conscious.        The “IV. Directions Regarding My End Of Life Care” article of this directive contains several areas where you can deliver specific preferences you wish followed or considered (depending on the statement you initialed above) You must initial the blank lines corresponding to each statement you wish used as a description of your wishes. The section that will wish to display one of your decisions is “A. Statement Regarding End Of Life Care.” If you initial this statement, you will inform all Reviewers that you do not wish your “…Life To Be Prolonged By Life Support…” even if only feeding tubes are required.    The second part of this article “B. Additional Directions Regarding End Of Life Care” will present several statements choices to apply during some possible scenarios (beginning with “I.) Close To Death”). Initial one of the blank lines attached to the statement choices (“I Want To Receive Tube Feeding,” “I Want Tube Feeding Only As My Health Care Provider Recommends,” or ” I Do Not Want Tube Feeding”) to demonstrate your stance on whether you will allow your life to be prolonged by being fed nutrients/liquids through a tube and if so, to what extent. Keep in mind you may include additional directives regarding this in an attachment after initialing your choice.        The next area bearing the “Initial One (1)” heading concerns itself with your preferences on having your life dependent upon machines or long term medical maintenance (i.e. for breathing, digestion, excretion, etc.) when you are “Close To Death.” The first statement will indicate that you want any means of such life support applied when required to prolong your life, the second statement indicates you want life support under the recommendations of your Health Care Provider, while the third statement declares you do not want to be maintained artificially. Initial the sentence that best describes your feelings of whether life support should be applied when you are permanently unconscious.             

The next part of this article will function very similarly, in that it will also request your input on one of the three statements regarding tube feeding and one of the three regarding life support to inform anyone reading this document what your wishes are. In “II.) Permanently Unconcious,” initial the statement under the first “Initial One” heading to indicate your feelings on being fed artificially while “Permanently Unconscious.”      Next, initial the statement that best applies to your wishes regarding life support when you will be unconscious with little to no hope of regaining consciousness. Three statements will allow you to seek life support whenever necessary, only under the recommendation of your Health Care Provider, or to deny it altogether. The third section here “III.) Advanced Progressive Illness” anticipates a solid report on what you prefer when you are incapacitated by disease. As with the above section, three topics will be dealt with and in each of these three topics, you must initial the blank space that best applies to the course of action you wish the Health Care Representative to take on your behalf. The first of these subjects is that of artificial feeding (where you will receive your nutrients and liquids through a tube). If you approve of others maintaining your health in this manner when you are too incapacitated to feed yourself, then initial the “I Want To Receive Tube Feeding Statement.” If you prefer to have your Health Care Provider make this decision, then the second statement must be initialed. If you do not want nutrients or liquids delivered when you are unable to feed yourself or drink on your own then initial the “I Do Not Want…” statement.      The second part of this section will require a definition as to whether or not you approve of life support being administered if you have an “Advanced Progressive Illness” and can no longer communicate. If you wish to be kept alive artificially whenever this is necessary then, initial the first statement to indicate your intent to survive or the second statement to pass this decision to your Health Care Provider. If you do not want any life support after being incapacitated by an Advanced Progressive Illness then, initial the third statement.        The next part “IV.) Extraordinary Suffering” will present a scenario where you have been rendered unable to communicate and are suffering greatly. Again the maintenance that can prolong your life will need to be addressed with your direct participation. Use the first “Initial One (1)” area of this section to indicate whether you wish to “Receive Tube Feeding” to prolong your life even when suffering greatly, to leave this decision-making process to the Health Care Provider, or to deny tube feeding when incapacitated and suffering. Initial the first, second, or third blank space (respectively) to indicate the policy you wish instituted when tube feeding is necessary to keep you alive when suffering.  Life support can be provided to you in many cases when you are unable to communicate or unconscious and suffering. If you wish such measures taken regardless of the consequence of continuing to suffer then initial the first statement. If you would rather this decision follows the Health Care Provider recommendations then initial the second statement. The third statement in this area should only be initialed if you will not authorize life support machines to prolong your life if you are suffering.               The final article of this document will also require your direct participation, however, before you proceed to “V. Signature,” reread your selections and make sure any attachments you wish containing your instructions are present and physically attached. Once these actions have been completed, sign your name on the blank line labeled “My Signature” and enter the current calendar date for this signature on the adjacent line. This action must take place before either a Notary Public or two Witnesses.         After signing this document, you as the Principal must relinquish it to the individual providing authentication to your signature. If this is a Notary Public then this party will verify the state and county where this document is executed, the individuals appearing before him or her, and provide his or her credentials.   If your signature will be authenticated by two Witnesses, then present them with this document. Each Witness must print his or her name on a unique “Witness Name…” line then sign and date the lines labeled “Signature” and “Date.”
Whichever party verified your signature will need to present this document to the Health Care Representative and Alternate Health Care Representatives. In “VII. Acceptance By My Health Care Representative” The Health Care Representative must formally accept the power being granted to him or her by printing and signing his or her name on the “Printed Name,” “Signature,” and “Date” lines under the title “Health Care Representative.”        In addition to the Health Care Representative, the Alternate Health Care Representatives will need to print and sign their names then supply their signature dates in the space provided under the title “First (1st) Alternate Health Care Representative” and “Second (2nd) Alternate Health Care Representative.”         


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