Hi everyone, I hope that you can help me out! I'm a graduate student studying medical ethics, and I'm seeking information regarding these cards. What I need to find out is this: 1) Do these cards need to be dated AND signed by TWO witnesses in order to be considered valid? 2) What happens if someone lacks this complete information, and has ONLY signed it themselves -- should their wishes still be respected, if they are in need of emergency medical care? (assuming they're unconscious, and this card if their only form of "consent" (or lack thereof!) I'm just seeking the importance of having the cards filled out completely -- this is in issue that I am required to address/research, and I sincerely hope to hear back from you! Thanks so much -F
Question: Advance Medical Directive/Release cards
by Facet 8 Replies latest watchtower medical
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JWdaughter
You might want to check a local hospital admittance office, or a doctors office, or a quick call to an attorney who deals with medical issues if you don't get an answer here. Its a legal question, and here you will get a lot of opinions. Some may have had experience though, so stick around and you may learn some things that are useful to you, even if they are purely anecdotal in nature. There may be information on http://www.ajwrb.org/ which is a site exclusively about JWs and blood. You will find a lot of good information there.
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OnTheWayOut
It would vary slightly from state to state, country to country.
In general, in the U.S., if you don't have it filled out, signed and witnessed by two,
then a judge would go easier on violating your wishes, and a doctor might be
quicker to not wait for the judge since his legal dept. will tell him that he will be
sued if he doesn't give the blood, but the client's family won't have a good case
for sueing if he does give the blood.I am somewhat familiar with emergency care. If a DNR is not to be found, then
resusitation will take place. If it is found, but not properly filled out, then resusitation
will take place on an emergency level until the proper document can be found. If there
is no proper document, then resusitation and live saving measures will continue.I would assume the same or similar with Medical Directives.
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Oroborus21
[Attorney disclaimer. The following is information/opinion only. Always seek local legal advice for specific issues or circumstances pertaining to yourself.]
Howdy,
With all due respect to the legal eagles at Bethel, in my opinion the Society's "No Blood Card" is a woefully inadequate piece of legal expression. The card which is styled an "Advanced Medical Directive/Release" is more useful and likely to be held to limit liability of the health care provider than to be enforced/respected under most circumstances. In other words, the "release" part is more important and effective than the "advance medical directive" part. Let me explain.
The first thing to note is that the Blood Card is only meant to be relevant and indeed is only an issue when the person needing the blood is unconscious or otherwise unable to express for themselves that they wish to refuse blood (or whatever parts of blood). If the person is conscious and able to express their wishes, then the health care provider would follow the patient's wishes in accord with its policies which may or may not defer to the patient's wishes and have them sign their own release of liability forms, refuse treatment (if possible and if it wouldn't expose them to greater liability), or in some circumstances seek legal intervention.
The reason that I mention these rather obvious things is because sometimes I get the impression from Witnesses that they think that the purpose of the Blood Card is as a crib sheet, like they are going to pull it out and cite Acts 15, etc. Some might indeed do this but that isn't the reason for having the card and doesn't address the legal effectiveness of the document.
Thus, the central issue to consider is, in the situation that the person is unconscious (and absent other legal documents), whether the Blood Card is likely to impact the medical provider's decisions or not.
I submit that the Blood Card doesn't qualify as any of the three usual types of documents for this purpose and so whether or not it is given any weight or credence at all is going to be entirely dictated not so much by applicable law, but rather, by the particular policies of the health care provider and maybe even by the personal decisions of the individuals involved.
[Incidently, this is probably why the Society now pushes its real durable power of attorney instead.]
Permit me to explain further....
There have been historically three forms of setting forth one's wishes in advance as far as medical treatment/emergency care goes. These are: 1) documents termed "living wills", 2) "health care proxies" and 3) "durable power of attorney" (for health care) aka "advanced medical directives."
Living wills specify medical treatment or in this case it would be the refusal of a particular treatment in the event the person becomes incapacitated. The Society's Blood Card is closest to this form of legal document, even if it is vague on whether a person could take their own blood like in cell recovery or autologous machines (sp?) since it only refers to "blood transfusions," but note that no where in the "legal directive" portion of the card does it state that the document is to be effective upon the person's incapacity or what would constitute such an incapacity. I think this may be a critical flaw in the document. Since there is no specificity of WHEN the document is supposed to be rendered effective, it is likely that a health care provider could consider it no more than "information" about the person's religious beliefs. Secondly, while some living wills have been upheld they are pretty much disfavoured. Third, the document would have to satisfy all of the requirements of the statute of wills whatever these may be in the person's state. So if holographic wills or wills which are not notarized are not ok, there may be problem there.
Health care proxies and Durable Power of Attorneys function essentially the same way and these are what are preferred by the courts and the medical field. But note very carefully what they do: They give someone else the right to make medical decisions for you under specified conditions.
Now look at the Blood Card carefully. Do you see anywhere that it actually does that?
The front and back sides (back of the front as folded) we can ignore here as these are just the front and in back it just has spaces to note allergies, etc.. The opposite folded side has the places for one "Emergency Contact" info and an alternate.
The inside is the purported "legal directive" that contains the (crap) we all know and love, has the signature section and is the part that is witnessed by two witnesses. Note carefully what the last paragraph states:
I authorize the person(s) named on the reverse to see that my instructions set forth in this directive are upheld and to answer any questions about my absolute refusal of blood.
Several problems here.
1) The persons named on the reverse are the emergency contact info. (Not the two (elder) witnesses who signed the card.) These are often family members who may or may not support the no blood decision. Witnesses who do want their wishes upheld better make sure the emergency contacts are fully supportive.
2) More importantly instead of explicity stating that the persons on the reverse have the right to MAKE the medical decisions in the person's stead, it only says that they are authorized to see that the person's instructions are "upheld."
What does that mean? It might mean that the persons named are given the right to go to court and represent the person as kind of power of attorney to get a court order for no blood but that clearly isn't going to have any legal effect outside of doing just that. I suppose they can talk, scream, cajole, etc. the medical provider in an attempt to "uphold" the person's decision but there's no legal reason why the provider has to even listen and in fact absent explicit authority they couldn't just defer the decision to named persons. (And as for the latter part of "answering any questions about my absolute refusal of blood" this couldn't possibly be understood to vest decision making authority in the named persons, it clearly states that such persons are to be consulted if the provider has "questions.") [Humor aside: Yeah I got a question. Is your son/daughter really this stupid?]
3) Third is the major problem already pointed out. No trigger. All health proxies and advanced medical directives SPECIFY not only that the document is effective only upon incapacitance but most go into detail as to what constitutes incapacity. And most advanced medical directives go into detail as to what treatments the person is authorized to approve and as to what decisions the person is authorized to make. Further, these documents conform to a legal standard including form, witnesses and notarization.
The botom line is that without a specific statement about WHEN the directive is effective and explicitly empowering someone else to make medical decisions on behalf of the incapacitated Witness, the document is useless as a either a healthcare proxy or an advanced medical directive!
Thus the problems with interpreting the document are tremendous for the healthcare provider, nevermind deciding whether to comply with or face the potential consequences of not complying in the heat of the moment.
In our court system we still have a little thing called damages that shapes a lot of outcomes and decisions. True, someone's civil rights may be violated if they are transfused without their consent and without a court approval, but if their life is saved or no harm comes from the violation, a judge is not likely to impose massive damages and might only award nominal damages, in a situation such as this one. (Unless they were extremely libertarian.) If I was a risk assessment coordinator, I would take that over the possibility of having the person die (or be injured) then facing wrongful death or negligence lawsuits from the family or estate of the deceased or the remorseful patient. [This is not to say that blood transfusions always result in better outcomes or are the difference between a person livng or dying; but it is probably a safe assumption to believe that is true in the majority of serious cases.]
Anyway that is my two cents.
-Eduardo
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Oroborus21
PS Facet:
to more directly answer your specific question. If the document is not signed by the two witnesses and isn't dated, thus filled out incorrectly and only signed by the person, that could present a big problem in viewing it as a kind of "living will" and it would only be for that purpose to consider the absence or presence of such signatures. (Though as I said above it really doesn't fit as a living will since it doesn't specify when it would be effective among other defaults.)
In States which recognize handwritten (holographic) wills, these don't need to have witnesses, but there are still issues of genuineness and whether the writing represents the true will of the person. Also, these situations are usually pertaining to the deceased and property dispersement situations, I've never heard of a living will for a medical directive that wasn't signed by witnesses.
Additionally, since there are clearly two lines for witnesses on the printed form, a health care provider might view the absence of signatures as meaning that the person bearing the card did not intend to complete the document and thus it should not be given any weight in their decision making at all.
In any case, the point is moot because the two witnesses are NOT the decision makers as specified in the document itself and there aren't even any contact info or telephone numbers listed for them.
What would be in question is whether there was anyone named as the emergency contact(s) and whether the card should be understood to vest decision making power in the hands of those emergency contacts. As I stated in the previous post, I think it is pretty clear that the card does NOT do that.
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crazyblondeb
What was said in the 2 posts above mine is right. I've worked in the ER/ICU areas for many years. Any documents not filled out completely, are void. The "card" isn't really legally binding. That's why it is so important to fill out living wills or power of attorneys.
shelley
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Thegoodgirl
"Facet", I think I know you in real life!
Anyway, if it is who I think it is, I will be attending your seminar next Wednesday to find out what you have to say on this exact topic, for which I saw the flyer today. "Graduate student"? :)
The truth is, Facet, it is extremely unlikely for a JW to not have filled out the blood card completely. These cards are filled out under extreme pressure (in my opinion) once a year after a sermon on the topic. Then there are specific church leaders ("elders") assigned to different members of the congregations to make sure each one has their card filled out completely. I just don't think this scenario would come up very often given the circumstances.
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Lady Liberty
Dear Facet,
Welcome!!
Sincerely,
Lady Liberty
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blondie
The WTS is moving away from using the "blood cards" or the Advance Medical Directive/Release cards. The cards have been combined with a health care power of attorney (or proxy) form. These do not have to be filled out every year but only if you move to another state or change those acting for you. They are really designed for use if you should be unconscious since you can clearly make you wishes known if you are awake. As has been stated, they are not valid if they are not filled out properly. I have known JWs to deliberately not fill one out and be telling the doctor as the are going down to surgery that they will not take blood. In one large city, a no-blood clinic had a seminar specially for JWs. About 100 attended, including many elders. The speaker (not a JW) said that they clinic would be happy to treat any and all JWs but that they must file a POA with the clinic some time prior to surgery. Six months after the seminar, the clinic had received only 2 POAs. I wonder why??????
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km12/04p.7NewProvisiontoAssistUstoAbstainFromBlood***The Governing Body has approved combining the essential elements of the durable power of attorney (DPA) document and the AdvanceMedicalDirective/Release card into a single legal document, which we shall refer to generally as a DPA card. A DPA card has been prepared for each state. The actual title of the DPA card varies from state to state.
You will need to fill out the DPA card for your state of residence only. The DPA card is valid indefinitely anywhere in the United States and will serve as a statement of your wishes when you travel internationally. In the future, you should fill out a new DPA card if (1) you need to make any changes to your DPA card, such as changing your wishes, health-care agents, addresses, and telephone numbers, or (2) your DPA card has been lost or destroyed.
The DPA card should be prayerfully considered and carefully filled out at home. However, before signing the card, it is important that the legal formalities be closely followed. For example, if your card says that two witnesses are required to see you sign, they should be present when you sign it. Book study overseers may periodically check with those who have not filled out new cards to see if assistance is needed.
Before folding the DPA card, make good-quality photocopies for your health-care agent, alternate health-care agent, and doctor as well as for your own records. You may also want to provide copies for other family members and the congregation secretary. Copies should be single-sided on standard-size (8 1/2? x 11?) paper, with the DPA card centered on the page. The original DPA card, not a photocopy, should be kept on your person.
The IdentityCard with the print date of 3/99 for unbaptized children of Witness parents has not changed. Parents should ensure that a card for each minor child is properly filled out and signed and that the child carries it at appropriate times.
Unbaptized publishers may adapt the language of the DPA card and IdentityCard in order to write out health-care instructions for themselves and their children. The secretary should provide a DPA card for all newly baptized publishers during the year.