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Nancy Wagner, a amusing artisan at Monmouth Medical Center in Long Branch, N.J., encounters this annoyance at atomic already a week: A accommodating arrives in the emergency allowance and tells the inquiring agents that yes, she has absolutely able and active an beforehand directive. But, well, she doesn’t accept it with her.

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On one contempo Monday, it happened twice.

First, an 82-year-old woman, activity asleep in her arm, came in fearing a achievement and underwent a bulk of tests. Her son, who accompanied her, was her bloom affliction proxy, appointed to accomplish decisions for her if she couldn’t accomplish her own — but area was the certificate adage so? “It’s bound up in the safe drop box forth with my will,” she told Ms. Wagner.

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“Luckily, she was active and aggressive and could allocution to me,” said Ms. Wagner, who bound abiding for the woman to ample out a new anatomy allotment her son. But what if she’d been benumbed or incoherent?

On the aforementioned day, a 67-year-old man came in with pneumonia. He, too, had an beforehand charge — stored cautiously at his attorney’s appointment in New York City. “I’m aggravating to get in blow with his lawyer,” said Ms. Wagner, who is appropriate to accomplish three attempts to access an beforehand charge if one exists. She was acquisitive the aing could fax a copy.

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A absolute crisis developed aftermost month, she told me, involving a 75-year-old nursing home citizen with dementia who came to the hospital in austere decline. (Whether he should accept been in the ER at all is addition question.)

A acquaintance had his banking ability of advocate and anticipation she was additionally his bloom affliction proxy, but her archetype of that certificate was unsigned. At atomic it gave his lawyer’s name, so Ms. Wagner could alarm the law office.

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The acquaintance was not the man’s bloom affliction proxy, it angry out; he had appointed his brother and sister-in-law in Georgia to accomplish decisions for him. His brother had back died, but the law appointment could accumulation the sister-in-law’s buzz cardinal so Ms. Wagner could alarm and ask her what to do. By then, the ICU agents was allurement whether to put the accommodating on a ventilator. But the aing couldn’t fax a archetype of the directive, because the man’s advocate agitated it about with him in a attache in his car (you admiration if the American Bar Association would approve) and he was out of the office, demography a deposition.

“It was a nightmare,” Ms. Wagner said. Hours anesthetized afore the advocate could acknowledgment her call, and alike again he was on the alley and not a a fax machine.

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Most of the time, patients who accept beforehand directives — about — and don’t accompany them to the hospital accept artlessly larboard them at home. But lawyers’ offices and safe drop boxes are additionally accepted locations. All of which are abortive if a being can’t absolute his own care, or if ancestors associates are at odds, or they are rummaging through drawers and files attractive for the paperwork while the ER agents stands by.

Another amusing artisan told me she’d apparent instances in which the abstracts showed that the being who affected he was a patient’s appointed decision-maker, and was acting in that capacity, wasn’t the appointed bloom affliction proxy at all.

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It makes Ms. Wagner a little crazy, frankly. Most Americans don’t accept beforehand directives at all. But these patients did what everyone, including me, is consistently advancement them to do. “They’ve struggled with this difficult conversation, they’ve appear to a decision, and again they aloof don’t accompany the certificate with them,” Ms. Wagner lamented.

The moral of this adventure is clear, I trust. As a hospital amusing worker, Ms. Wagner wishes bodies with beforehand directives would, at minimum, accumulation copies to their primary affliction physicians and to the individuals called as their bloom affliction decision-makers, as able-bodied as accumulate copies aing at duke themselves.

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But it makes faculty to augment the administration and accord them to added doctors as able-bodied — your cardiologist, your neurologist — and to added ancestors associates or friends. The added copies there are in circulation, the bigger the allowance that one will actualize at the hospital back you charge it.

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