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In the landscape of healthcare decision-making, the Alabama Directive for Health Care form (Living Will and Health Care Proxy) emerges as a significant document intended to convey an individual's preferences regarding medical treatment and care in scenarios where they are unable to articulate these desires themselves. This form, legal within the boundaries of Alabama, ensures that the wishes of individuals concerning the acceptance or refusal of life-sustaining treatment, artificially provided food and hydration, and other specific medical directives are respected at times when they cannot communicate due to severe illness or incapacity. It outlines provisions for selecting a health care proxy—an appointed individual authorized to make healthcare decisions on behalf of the incapacitated person, should there be no prior directive made by the person or in decisions extending beyond the written directions. Furthermore, it acknowledges the individual’s right to alter or revoke these directives at any time, emphasizing autonomy over one’s health care decisions. This document not only acts as a guide for healthcare providers and loved ones in critical moments but also confronts ethical considerations surrounding end-of-life care, underscoring the importance of ensuring that one's wishes are known and adhered to in times of vulnerability.

Alabama Directive Health Care Example

AD V AN CE D I RECTI V E FOR H EALTH CARE

( Liv in g W ill a n d H e a lt h Ca r e Pr ox y )

This form may be used in the State of Alabama to make your wishes known about what medical treatment or other care you would or would not want if you become too sick to speak for yourself. You are not required to have an advance directive. If you do have an advance directive, be sure that your doctor, family, and friends know you have one and know where it is located.

Se ct ion 1 . Livin g W ill

I, ___________________, being of sound mind and at least 19 years old, would like to make the

following wishes known. I direct that my family, my doctors and health care workers, and all others follow the directions I am writing down. I know that at any time I can change my mind about these directions by tearing up this form and writing a new one. I can also do away with these directions by tearing them up and by telling someone at least 19 years of age of my wishes and asking him or her to write them down.

I understand that these directions will only be used if I am not able to speak for myself.

I f I be com e t e r m in a lly ill or in j u r e d:

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

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

Place your initials by either “yes” or “no”:

I want to have life sustaining treatment if I am terminally ill or injured. ____ Yes ____ No

Artificially provided food and hydration (Food and water through a tube or an IV) – I understand that if I am terminally ill or injured I may need to be given food and water through a tube or an IV to keep me alive if I can no longer chew or swallow on my own or with someone helping me.

Place your initials by either “yes” or “no”:

I want to have food and water provided through a tube or an IV if I am terminally ill or injured.

____ Yes ____ No

I f I Be com e Pe r m a n e n t ly U n con sciou s:

Permanent unconsciousness is when my doctor and another doctor agree that within a reasonable degree of medical certainty I 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 me long enough to make that decision. I understand that at least one of these doctors must be qualified to make such a diagnosis.

Life sustaining treatment – Life sustaining treatment includes drugs, machines, or other medical procedures that would keep me alive but would not cure me. I know that even if I choose not to have life sustaining treatment, I will still get medicines and treatments that ease my pain and keep me comfortable.

Place your initials by either “yes” or “no”:

I want to have life-sustaining treatment if I am permanently unconscious. ____ Yes ____ No

Artificially provided food and hydration (Food and water through a tube or an IV) – I understand that if I become permanently unconscious, I may need to be given food and water through a tube or an IV to keep me alive if I can no longer chew or swallow on my own or with someone helping me.

Place your initials by either “yes” or “no”:

I want to have food and water provided through a tube or an IV if I am permanently unconscious.

____ Yes ____ No

O t h e r D ir e ct ion s: Please list any other things you want done or not done.

In addition to the directions I have listed on this form, I also want the following:

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

If you do not have other directions, place your initials here:

____ No, I do not have any other directions.

Se ct ion 2 . I f I ne e d som e one t o spe a k for m e .

This form can be used in the State of Alabama to name a person you would like to make medical or other decisions for you if you become too sick to speak for yourself. This person is called a health care proxy. You do not have to name a health care proxy. The directions in this form will be followed even if you do not name a health care proxy.

Place your initials by only one answer:

_____ I do not want to name a health care proxy. (If you check this answer, go to Section 3)

_____ I do want the person listed below to be my health care proxy. I have talked with this person

about my wishes.

First choice for proxy: ________________________________________

Relationship to me: __________________________________________

Address: ____________________________________________________

City: ____________________________ State _______ Zip ___________

Day-time phone number: _______________________________________

Night-time phone number: ______________________________________

If this person is not able, not willing, or not available to be my health care proxy, this is my next

choice:

Second choice for proxy: _______________________________________

Relationship to me: __________________________________________

Address: ____________________________________________________

City: ____________________________ State _______ Zip ___________

Day-time phone number: _______________________________________

Night-time phone number: ______________________________________

Instructions for Proxy

Place your initials by either “yes” or “no”:

I want my health care proxy to make decisions about whether to give me food and water through a tube or an IV. ____ Yes ____ No

Place your initials by only one of the following:

____

I want my health care proxy to follow only the directions as listed on this form.

_____

I want my health care proxy to follow my directions as listed on this form and to make any

 

decisions about things I have not covered in the form.

_____

I want my health care proxy to make the final decision, even though it could mean doing

 

something different from what I have listed on this form.

Se ct ion 3 . Th e t h in gs list e d on t h is for m a r e w h a t I w a n t .

I understand the following:

§If my doctor or hospital does not want to follow the directions I have listed, they must see that I get to a doctor or hospital who will follow my directions.

§If I am pregnant, or if I become pregnant, the choices I have made on this form will not be followed until after the birth of the baby.

§If the time comes for me to stop receiving life sustaining treatment or food and water through a tube or an IV, I direct that my doctor talk about the good and bad points of doing this, along with my wishes, with my health care proxy, if I have one, and with the following people:

____________________________________________________________________

____________________________________________________________________

Se ct ion 4 . M y signa t ur e

Your name: _______________________________________________________

The month, day, and year of your birth: _________________________________

Your signature: ____________________________________________________

Date signed: _______________________________________________________

Se ct ion 5 . W it n e sse s ( n e e d t w o w it n e sse s t o sign )

I am witnessing this form because I believe this person to be of sound mind. I did not sign the person’s signature, and I am not the health care proxy. I am not related to the person by blood, adoption, or marriage and not entitled to any part of his or her estate. I am at least 19 years of age and am not directly responsible for paying for his or her medical care.

Name of first witness: ___________________________________

Signature: _____________________________________________

Date: _________________________________________________

Name of second witness: _________________________________

Signature: _____________________________________________

Date: _________________________________________________

Se ct ion 6 . Sign a t u r e of Pr ox y

I, ____________________________________________, am willing to serve as the health care proxy.

Signature: ________________________________________

Date: _________________________

Signature of Second Choice for Proxy:

I, __________________________, am willing to serve as the health care proxy if the first choice

cannot serve.

Signature: ________________________________________

Date: _________________________
▼ PDF File

Form Specs

Fact Detail
Legal Age Must be at least 19 years old to make a directive.
Sound Mind Requirement The individual must be of sound mind to create a directive.
Definition of Terminally Ill or Injured Condition cannot be cured and likely to result in death soon, as agreed by two doctors.
Life-Sustaining Treatment Includes drugs, machines, or medical procedures that do not cure but keep the patient alive.
Artificially Provided Food and Hydration Option to choose if food and water should be provided through a tube or IV if terminally ill or permanently unconscious.
Permanent Unconsciousness A condition without hope for improvement, as agreed by two doctors, where the patient can no longer think, feel, move knowingly, or be aware of being alive.
Health Care Proxy Option to name a proxy to make decisions if the individual becomes unable to communicate their wishes.
Governing Law Alabama state laws govern the creation and interpretation of Advance Directives for Health Care.

Detailed Guide for Writing Alabama Directive Health Care

Filling out the Alabama Directive for Health Care form is a significant step in making your health care wishes known in the event that you are unable to communicate them yourself. This document allows you to state your preferences regarding life-sustaining treatments and appoint a health care proxy, who can make decisions on your behalf if necessary. The process requires careful consideration and clear communication of your wishes. Here are the steps you should follow to complete the form accurately.

  1. Start with Section 1: Living Will. Write your full name, confirming that you are of sound mind and at least 19 years old. Decide on your medical treatment preferences in case you become terminally ill or permanently unconscious. Initial your choices regarding life-sustaining treatment and artificially provided food and hydration.
  2. In the Other Directions part, specify any additional care preferences. If you have no further directions, initial to indicate your decision.
  3. Move to Section 2 if you wish to appoint a health care proxy. Initial whether or not you want to name a health care proxy. If you decide to appoint one, provide the details of your first choice for a proxy, including their relationship to you, address, and phone numbers. Also, list a secondary choice in case your primary choice is unable to fulfill their duties.
  4. Decide how much authority you want your health care proxy to have. Do you want them to make decisions about artificial nutrition and hydration? Should they strictly follow the directions on this form, or can they also make decisions on matters not covered here? Place your initials next to your preferences.
  5. Read and understand the declarations under Section 3, acknowledging the instructions regarding your directions and the provision of your care under specific conditions, such as pregnancy.
  6. In Section 4, provide your name, date of birth, and signature along with the date you are signing the form to validate your directive.
  7. For Section 5, have two witnesses sign and date the form. Ensure these individuals are not your health care proxy, related to you by blood, marriage, adoption, are not beneficiaries of your estate, and are not directly responsible for your medical care costs. They also must believe you are of sound mind as you sign this directive.
  8. If you have appointed a health care proxy, Section 6 requires their acknowledgment. Your chosen proxy (and alternative, if applicable) should provide their names, signatures, and the date they agree to perform their duties as described.

After completing the form, inform your family, friends, and doctors about your advance directive, and keep the document in a safe, easily accessible place. It’s wise to review and update it periodically to ensure it reflects your current wishes regarding your health care.

Common Questions

What is an Advance Directive for Health Care in Alabama?

An Advance Directive for Health Care in Alabama is a legal document that allows individuals, who are of sound mind and at least 19 years old, to state their wishes regarding medical treatment and care in the event that they become unable to communicate these wishes themselves. This document serves as a guide for family, doctors, and health care workers, instructing them to either provide or withhold life-sustaining treatments or artificially provided food and water based on the individual’s preferences.

Do I need to have an Advance Directive?

Having an Advance Directive is not mandatory. However, it is strongly recommended as it ensures that your health care preferences are known and considered in situations where you might not be able to articulate them yourself. Informing your doctor, family, and friends about your directive and its location can be crucial for its effective implementation.

Can I change my Advance Directive after I’ve completed it?

Yes, you are at liberty to change your Advance Directive at any time. Changes can be made by destroying the original document and creating a new one or simply by verbally conveying your new wishes to someone at least 19 years of age, who should document these changes. It is important to communicate any changes to your health care proxy, family, and health care providers to ensure your current wishes are followed.

What if I become terminally ill or permanently unconscious?

The Advance Directive allows you to specify your treatment preferences under these critical conditions. If you are terminally ill or injured, meaning a condition from which recovery is not expected and death is imminent, or if you become permanently unconscious without hope of recovery or awareness, you can choose whether to receive life-sustaining treatments and artificially provided nutrition and hydration.

How does one appoint a health care proxy in Alabama?

In Section 2 of the Advance Directive form, you have the option to designate a health care proxy, someone you trust to make health care decisions on your behalf if you are unable to do so. You are not obligated to appoint a proxy, but if you choose to, you should discuss your wishes with this person thoroughly. The document allows for the designation of a primary proxy and an alternative, should the first choice be unable or unwilling to act in that capacity.

What should I do if I do not want to appoint a health care proxy?

If you decide not to appoint a health care proxy, you must indicate this preference by initialing the appropriate section in the Advance Directive form. Even without a designated proxy, the medical treatment preferences outlined in your directive will still be respected and followed by health care providers.

Are there any circumstances where my Advance Directive might not be followed?

Yes, there are specific situations where an Advance Directive may not be followed. For instance, if your doctor or hospital is unwilling to comply with your wishes as stated in the directive, they are required to transfer you to a provider who will. Additionally, if you are pregnant or become pregnant, the preferences indicated in your Advance Directive may not be executed until after the birth of the baby.

How do I finalize my Advance Directive in Alabama?

To finalize your Advance Directive, you must sign and date the document in the presence of two witnesses, who must also sign and date the form. These witnesses must be of sound mind, at least 19 years old, not related to you by blood, adoption, or marriage, not entitled to any part of your estate, and not directly responsible for your medical care. Following this, your Advance Directive becomes a legal document, reflecting your health care preferences.

Common mistakes

Completing the Alabama Directive for Health Care form is a significant step in planning for future medical care, but mistakes can hinder its effectiveness. Understanding these common errors can ensure your wishes are clearly communicated and followed.

  1. Not specifying preferences clearly. The form allows individuals to state their wishes regarding life-sustaining treatment and artificially provided food and hydration. A common mistake is not clearly initialing your choices under these critical sections. Ambiguity here can lead to confusion among healthcare providers and loved ones about your true preferences at a time when you might not be able to express them yourself.
  2. Failing to appoint a health care proxy. While it's not mandatory to name a health care proxy, skipping this section can be a mistake. If a situation arises where your healthcare preferences are not explicitly covered in the document, a health care proxy can make decisions on your behalf, guided by their knowledge of your wishes and values. Not having a proxy means decisions could be made by someone not familiar with your preferences or by someone you wouldn’t choose to make those decisions for you.
  3. Incomplete or vague instructions for your health care proxy. When appointing a proxy, the form provides options regarding the extent of the powers granted to them, including decisions about artificially provided food and water. A mistake often made is not providing clear, explicit instructions or not discussing your wishes with your proxy ahead of time. This oversight can place your proxy in a challenging position, potentially leading them to make decisions that might not align with your intentions.
  4. Improper initialization or signing of the document. The form requires your initials and signature at specific points to validate your choices and consent. Overlooking these requirements or not properly executing them can invalidate your directives or create legal challenges at a time when swift medical decisions might be necessary. Additionally, make sure your witnesses meet the criteria outlined in the document to avoid any questions about the validity of their witnessing.

Ensuring your Alabama Directive for Health Care form is correctly filled out and free from these common mistakes can provide peace of mind that your healthcare preferences are known and respected. Always discuss your decisions with your family, health care proxy (if appointed), and health care providers to minimize misunderstandings and ensure your wishes are followed.

Taking the time to complete and regularly update your directive is not just about documenting your health care preferences; it's about making a statement about the values and care you wish to receive when you might not be able to speak for yourself. Avoiding these pitfalls is a crucial step in that process.

Documents used along the form

When preparing for the future, especially regarding healthcare decisions, it's pivotal to have a complete set of documents that ensure your wishes are respected and followed. Alongside the Alabama Directive for Health Care form, several other forms and legal documents are commonly used to bolster the directive's effectiveness and cover aspects that the directive itself may not address comprehensively.

  • Durable Power of Attorney for Finances: This form allows you to appoint someone to manage your financial affairs if you become incapacitated. It can cover a range of tasks from paying bills to managing investments.
  • Do Not Resuscitate (DNR) Order: A DNR is a medical order signed by a healthcare provider. It instructs healthcare professionals not to perform CPR if your heart stops or if you stop breathing. This is distinct from an Advance Directive and must be signed by a physician.
  • HIPAA Release Form: This document allows healthcare providers to share your health information with individuals you designate. It's crucial for family members or friends who need to make informed decisions about your care.
  • Living Will: While similar to the healthcare directive, a Living Will specifically outlines your wishes regarding end-of-life care. It becomes effective only under certain medical conditions, as certified by medical professionals.
  • Appointment of Health Care Representative: This form designates another person to make health care decisions on your behalf if you are unable. It's similar to naming a health care proxy but can include more detailed instructions.
  • Organ and Tissue Donation Form: This document allows you to specify what, if any, organs and tissues you wish to donate upon death. It can be part of your driver's license registration or a separate form kept with your other important documents.
  • Personal Medical History: While not a legal document, maintaining a record of your medical history, including conditions, treatments, medications, and allergies, can be invaluable for medical personnel responsible for your care.

Collectively, these documents can provide a comprehensive framework that ensures your health care wishes are understood and followed. By preparing in advance, you can alleviate the burden on your loved account, ensuring they are not left guessing about your preferences in critical moments. Remember, it's not only about filling out these documents but also about communicating your wishes clearly with your loved ones and healthcare providers.

Similar forms

The Alabama Directive Health Care form is similar to other legal documents intended to specify individuals' wishes regarding medical treatment and care in situations when they are unable to communicate those decisions themselves. These documents function as essential tools for ensuring that the healthcare choices align with the personal beliefs and preferences of the individual. Below are discussions on similar forms and their connections to the Alabama Directive Health Care form.

Medical Power of Attorney (Healthcare Proxy): Like the section in the Alabama Directive that allows the appointment of a health care proxy, a Medical Power of Attorney enables individuals to designate someone they trust (an agent) to make health care decisions on their behalf should they become incapable of making those decisions themselves. The crucial similarity lies in the empowerment of an appointed party to make medical decisions, adhering to the person's wishes as closely as possible. This component ensures that someone familiar with the individual's values can guide healthcare providers when the individual cannot communicate directly.

Living Will: The aspect of the Alabama Directive known as the "Living Will" bears a resemblance to standalone Living Will documents. A Living Will typically details specific treatments an individual wishes or does not wish to receive if they are dying or permanently unconscious and unable to communicate their health care preferences. Both the Alabama Directive's Living Will section and standalone Living Wills serve the critical function of guiding healthcare professionals and loved ones regarding end-of-life care, avoiding unnecessary or unwanted medical treatments, and clearly stating the individual's desires for life-sustaining measures, including the provision or withholding of food and water through artificial means.

Do Not Resuscitate (DNR) Orders: While not identical, the Alabama Directive Health Care form and Do Not Resuscitate (DNR) Orders share the fundamental aim of directing specific medical interventions during critical health emergencies. DNR Orders explicitly instruct healthcare providers not to perform cardiopulmonary resuscitation (CPR) if an individual's breathing stops or if the heart stops beating. Although the Alabama Directive encompasses a broader range of healthcare decisions, including the decision to forgo life-sustaining treatments under certain conditions, the essence of respecting an individual's preference in life-threatening situations is a common thread between these documents.

Dos and Don'ts

Filling out an Alabama Directive for Health Care form is a responsible step to ensure your healthcare wishes are followed when you can't speak for yourself. Here's a guide to help you approach this process thoughtfully.

Things You Should Do:

  • Read every section thoroughly to understand the decisions you're being asked to make. These decisions include your preferences for life-sustaining treatment, artificially provided nutrition and hydration, and choosing a health care proxy.

  • Discuss your decisions with close family members, friends, and your healthcare provider. This ensures they understand your wishes and can advocate for you when needed.

  • Clearly mark your initials next to your choices on the form. Your initials are required to indicate your decisions on life-sustaining treatments and the appointment of a health care proxy.

  • Choose a health care proxy who understands your values and is willing to make decisions on your behalf. Make sure to have a conversation with the person you choose to ensure they are comfortable with this responsibility.

  • Sign and date the form in the presence of two witnesses who meet the requirements stated on the form. This step is essential to legally validate your advance directive.

Things You Shouldn't Do:

  • Don't leave any section blank without marking your initials. If you do not have specific wishes for a section, such as additional directions, clearly initial the option indicating you have no additional directions.

  • Avoid choosing a health care proxy without discussing your health care wishes with them first. This conversation is crucial for ensuring they are prepared to make decisions aligning with your preferences.

  • Don't forget to inform your healthcare provider and family about your advance directive. Simply completing the form is not enough; you must communicate its existence and location to key individuals.

  • Do not pick witnesses who are also your health care proxy, related to you, or have a financial interest in your estate. Witnesses should be impartial to ensure the form's integrity.

  • Avoid assuming that this form alone is sufficient for all scenarios. Consider consulting legal guidance to ensure all aspects of your healthcare wishes are comprehensively covered.

Misconceptions

Misconceptions about the Alabama Directive for Health Care form are common, and it's important to clarify these misunderstandings to ensure individuals make informed decisions about their health care wishes. Here’s a breakdown:

  • Only for the Elderly: People often think that advance directives are only for older adults. However, any adult over 19 can and should have one to ensure their health care preferences are known, should they become unable to communicate.
  • Legal Assistance Required: Another misconception is that you need a lawyer to complete the form. This document is designed to be filled out without the need for legal assistance, making it accessible to everyone.
  • Revocation is Complicated: Some believe that changing or revoking the directive is a complex process. In reality, it can be as simple as destroying the document or creating a new one to reflect your current wishes.
  • Ignores Comfort Care: There's a misconception that choosing not to receive life-sustaining treatment means you will also forego comfort care. The form explicitly states that pain management and comfort care will continue regardless of other treatment decisions.
  • Permanent Decisions: Many think once an advance directive is signed, it's set in stone. On the contrary, individuals can update their directives as their health or preferences change.
  • Only Covers Terminal Illness: While it's true the directive addresses wishes in the event of terminal illness, it also includes preferences for if you become permanently unconscious or have other specific medical conditions.
  • Health Care Proxy is Mandatory: It's a common belief that you must appoint a health care proxy. While it's recommended, you can opt not to name one, and your care preferences outlined in the directive will still be honored.
  • Overrides in Pregnancy: There's a misconception that your directives will always be followed, no matter what. If you are pregnant, the form notes that your preferences may not be carried out until after the birth of the baby, addressing ethical and legal considerations.
  • Only about End-of-Life Care: Lastly, some believe advance directives only cover end-of-life decisions. While those are significant aspects, the form also includes provisions for other treatments and care that may not be immediately life-ending.

Understanding these misconceptions can help ensure your health care wishes are accurately represented and respected. Everyone should feel empowered to make informed decisions about their health care, and the Alabama Directive for Health Care form is a valuable tool in that process.

Key takeaways

The Alabama Directive for Health Care form is a comprehensive document that allows individuals to express their wishes regarding medical treatment and appoint a health care proxy in case they become incapable of making decisions for themselves. Here are key takeaways from the document:

  • Individuals must be at least 19 years old and of sound mind to fill out the form, ensuring that the directive is made voluntarily and thoughtfully.
  • The form includes a section for a living will, where individuals can specify their desires concerning life-sustaining treatment and artificially provided food and water if they become terminally ill or permanently unconscious.
  • It offers the option to appoint a health care proxy, a trusted person who will make medical decisions on the individual's behalf if they are unable to do so.
  • Individuals have the autonomy to decide whether they want their health care proxy to adhere strictly to the instructions provided or to make decisions based on unforeseen circumstances, highlighting the importance of thorough communication with the appointed proxy about one's values and wishes.
  • If there are any specific medical treatments or care preferences not covered under the standard provisions, the form provides space for additional instructions, ensuring personalized care.
  • The directive requires the signatures of two witnesses who confirm the individual's soundness of mind and voluntary choice, adding a layer of verification to the document.
  • Lastly, the document clarifies that if a medical provider is unwilling to follow the directives, they are obligated to transfer care to another provider who will uphold the individual's wishes, emphasizing the patient's right to have their choices respected.

This form serves as a powerful tool in medical planning, empowering individuals to make preemptive decisions about their health care and ensuring that those decisions are recognized and respected, even when they cannot communicate them themselves.

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