MARCH 2026 | 19 THE OKLAHOMA BAR JOURNAL Statements or opinions expressed in the Oklahoma Bar Journal are those of the authors and do not necessarily reflect those of the Oklahoma Bar Association, its officers, Board of Governors, Board of Editors or staff. to proactively consent or decline specific mental health treatment in advance of needing it. The directive becomes effective when a psychiatrist and another physician determine that the principal is unable to receive and/or evaluate and/or communicate to an extent that they lack capacity. In Oklahoma, “mental health treatment” includes the following by default: convulsive treatment, treatment with psychoactive medication and admission to and retention in a health care facility for a period of up to 28 days.24 A principal may modify this consent as well as outline their own unique needs, such as medication regimen, preferred hospital(s), trusted medical provider(s), successful conflict de-escalation techniques and/or other special instructions to their agent. Hospice and Dying at Home Hospice is a widely misunderstood and greatly underutilized end-of-life tool. Covered under Medicare, hospice provides free medical support to those at the end of life with a goal of easing suffering and making the last six months of a person’s life as pleasant as possible. The majority of the author’s clients express a sincere interest in dying at home and not in a hospital. However, the typical time spent on hospice is only around three weeks, and over 30% of Americans end up dying in the hospital.25 Including a simple provision stating a principal’s preference to die at home with the aid of hospice can make a significant difference in the quality of life and death of our clients. Addressing Pregnancy The recent Georgia case of Adriana Smith has sparked debate across the country with respect to whether a permanently unconscious woman should be forced to carry a pregnancy to term.26 The Oklahoma advance directive form specifically states that a pregnant woman cannot be taken off life support unless she states so in her advance directive ahead of time. For female principals of childbearing age, consider including the following permissive (not obligatory) provision: I specifically authorize that during a course of pregnancy, if my health care proxy believes I would not wish to be kept alive, that they may opt to remove life-sustaining treatment and/ or artificially administered hydration and/or nutrition shall be withheld or withdrawn. LGBTQ+ Issues While Obergefell27 rights are no longer in immediate danger,28 attorneys assisting clients who are part of LGBTQ+ communities may wish to include explicit protections, in case the right to gay marriage is ever challeneged again. The author includes the following provision in her documents for her LGBTQ+ clients: When a person is named as a relative in this document, that person shall be treated as the relationship listed, regardless of any (non-divorce/DV) governmental/judicial decisions, actual blood relation, or court record. Religious and Secular Preferences Religious or secular choices are also a way of helping our clients feel empowered to know they will die with the principles with which they lived. For religious families, outlining specific hospital(s) of choice, requesting the principal’s spiritual leader provide a blessing at the end of life and requesting religious services can help a client feel less nervous about dying. For secular families, specifically requesting to only be admitted to a secular hospital(s) can help ensure the principal feels safe and that their choices will be honored, regardless of religious affiliation. The following provision can help bolster this confidence: Any physician unwilling to comply with my directive shall immediately transfer my care to another health care provider. Until my care is transferred and accepted by a willing provider, my attending physician must comply with the medical treatment regardless of objection, if lack of action would likely result in my death. 63 OK Stat §3101.9 (Physician or health care provider unwilling to comply with act). CONCLUSION Every individual deserves the peace of mind that comes from knowing their health care wishes will be honored. By carefully preparing an HPOA and an advance directive and by adding provisions that reflect personal values and unique needs, attorneys can help their clients maintain control even during times of incapacity.
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