As a patient, you have the right to make informed decisions about your health care, including the right to accept or refuse medical treatment. Your physician will give you information about your condition, treatment choices available, and the risks and benefits of accepting or rejecting medical treatment. If you have any questions about your medical condition or the treatment choices available, please have a discussion with your physician.
If you become unable to make decisions regarding treatment, the decisions regarding your medical care become more difficult. Advance directives allow you to make and document decisions and preferences about your medical care now, when you are of sound mind and can communicate, to have those decisions or preferences apply in the future, should you become unable to make and communicate decisions. It is your responsibility to make your health care decisions known to your health care providers, including completing and providing advance directives to those health care providers.
There are various types of directives, as briefly explained below.
Medical power of attorney is a legal document that allows you to appoint an individual (called an agent) to make health care decisions for you if you become unable to make decisions for yourself. It is separate and distinct from other types of powers of attorney under which you appoint an individual to make legal and/or financial decisions for you.
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Directive to physicians and family or surrogates, also known as a living will, is an instruction regarding the administration, withholding or withdrawing of life-sustaining treatment when you have a terminal or irreversible condition and you are no longer able to make your wishes known.
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Out-of-hospital do-not-resuscitate (out-of-hospital DNR order) is a form that is prepared and signed by your attending physician that documents your instructions or the instructions of your legally authorized representative. It directs health care professionals in an out-of-hospital setting to not initiate or continue certain life-sustaining treatment. An out-of-hospital setting means a location in which health care professionals are called for assistance, including long-term care facilities, in-patient hospice facilities, private homes, hospital outpatient or emergency departments, physician’s offices, and vehicles during transport.
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The ideal time to complete an advance directive is when you have time to think about your options and preferences, study the forms, make your decisions, and discuss your wishes and preferences with your family, desired agent(s), physicians, friends, clergy, and others.
An advance directive is a deeply personal matter. It is recommended that you speak with your physician and family about such choices. If you want to complete an advance directive while you are in the hospital, please notify your nurse. Your nurse will then connect you with the person designated to provide education on advance directives as well as the requested documents.
No. You are not required to have an advance directive. You will not be forced to prepare an advance directive if that is not your desire. However, it is important to communicate your wishes to your physician and family before you are seriously ill, these documents will aid you in doing so.
If you do not have the ability to make medical decisions or if you are incapable of communicating, the person responsible for your health care decisions will be identified. The person responsible for your health care decisions may be asked about decisions such as starting or continuing artificial support or performing CPR, should it be needed, or allowing you to die as gently as possible.
No. An advance directive remains in effect until you choose to revoke it. Once you bring an advance directive to the hospital with you, it will be added to your electronic medical record for future hospitalizations.
You can revoke or change an advance directive at any time.
The medical power of attorney and directive to physicians documents are used when you no longer have capacity to make medical decisions for yourself. The out-of-hospital do-not-resuscitate document applies if you do not want to be resuscitated in out-of-hospital settings.
Keep your original advance directives in a safe place. Provide copies of your advance directives to your physician, the agent designated in the medical power of attorney, and other individuals you have identified. Communicate your wishes to your agent and family members so everyone is informed. By doing so, you can minimize potential conflict and maximize the possibility that your wishes will be carried out. By letting your wishes be known in advance, you also take the full burden of decision-making off the shoulders of your decision-maker; responsibility then becomes to carry out a decision you have already made. Should your medical decision-maker need guidance when asked to make a decision, or if there is conflict about what would be best for you, the hospital’s Ethics Committee can offer guidance regarding appropriate and ethical choices.