Health Care and Gay Men in the United States

BY Frank Spinelli, M D

June 30 2010 7:10 PM ET

 FIVE MEDICAL LEGAL ISSUES EVERY GAY MAN SHOULD CONSIDER

This section is meant to be informative only. Individual situations are likely to vary. I strongly urge you to contact and obtain legal advice and assistance from an attorney when considering any of these options. It is important to note that, depending on the state in which you reside, laws may vary, particularly with respect to civil unions, marriage, and domestic partnerships as they relate to gay people.

1. DNR, or Do Not Resuscitute order. This is a document that provides your family and healthcareproviders with instructions to not place you on artifi cial life support in case of heart or lung failure, especially if you are unable to make a conscious decision at the time. The DNR is a written order from a doctor indicating that you do not wish to be “coded.” Such an order may be instituted on the basis of an advanced directive from a person that is entitled to make decisions on your behalf, such as a health care proxy. In situations where you do not have a health- care proxy then either your spouse, partner, or your closest living relative gets to make these decisions on your behalf as determined by the applicable state law. In the United States, a valid DNR will ensure that cardiopulmonary resuscitation, and advanced life support will not be performed. To ensure that your DNR is honored, be sure to instruct your partner, family, friends, and doctors of your wishes. A DNR order must be specific and the terms should be laid out. For example, some individuals are specific about not wanting CPR yet will allow mechanical ventilation, feeding tubes, and pain management. In any case, discuss the specifics with your doctor.

2. A living will. A type of advanced healthcare directive often accompanied by a specific type of power of attorney or health-care proxy. Generally speaking it has to be witnessed and notarized. A living will covers specifi c instructions as it pertains to your treatment, even if you are unable to give an informed consent at the time due to incapacity. A DNR can be part of a living will. A living will is a statement of your wishes regarding end- of-life care. Unlike a health- care proxy, a living will does not empower another person to make important medical decisions if you are incapacitated.Instead, a living will gives direction to your healthcare provider or representative regarding what mea sures you want taken to prolong life and can serve to help assure that your wishes are being followed.

It is recommended that you obtain both a health- care proxy and a living will to ensure that your preferences about medical treatment are honored. Remember once again this is crucial. Recall the recent case involving Theresa Schiavo, who was declared brain dead but remained alive with the help of a feeding tube. Her parents battled with her legal husband about maintaining her life with the aid of this feeding tube, despite the fact that her legally recognized husband thought otherwise. In the case of a gay husband the wishes of the parent would likely be upheld.

3. A health-care proxy. Another legal document used in the United States in order to empower someone you have appointed to make health-care decisions in the event that you are incapable of doing so. The proxy cannot make a health- care decision as long as you, the primary individual, have the capacity to do so. They allow the patient’s wishes to be followed when he is incapable of communicating them. Unless you have a documented proxy, decisions made on your behalf will be deferred to your next of kin, not your partner.

4. A power of attorney. They can be general or specific. Essentially, it is an individual appointed by you who will act on your behalf in legal and financial decisions should you be unable to do so. This will allow a designated person to sign certain documents on your behalf and make informed decisions depending upon what you have authorized this person to do.

5. A last will and testament. In the event of your death, a last will and testament will ensure proper distribution of your money, assets, and property to the desired individuals. Without a written will, your estate will be distributed to your legally recognized family. In the event of one of the deaths of a partnership, in the absence of a valid last will and testament, money, assets, and property would go to the closet legally recognized living relative, not his partner.













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