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You Life, Your Decisions
Have you thought about what kind of health care you would want to receive if you became very ill or hurt? If you were no longer able to express your wishes, would your family and doctor know what you would want?
The American Academy of Family Physicians provides an excellent explanation of an advance directive and includes a sample advance directive form.
The Center for Practical Bioethics provides planning information and a Healthcare Directive and Durable Power of Attorney for Healthcare form.
What are Advance Directives?
Formal Advance Directives are papers written before a serious illness that state your choices for health care (Health Care Treatment Directive), or name someone to make those choices (Durable Power of Attorney for Health Care Decisions) if you become unable to make those decisions. Through Advance Directives, you can make valid decisions about your future medical care. Advance Directives can also state your wishes to donate specific organs.
Another important way to make your wishes known is to talk to your family and your physician about what you want.
What is a Health Care Treatment Directive
A Health Care Treatment Directive is a document in which you can tell your doctor when to stop life-sustaining treatments and let you die naturally. A Health Care Treatment Directive is used when you can no longer make your own decisions, when you are terminally ill with no hope of recovery, and when the use of life-sustaining treatments would only prolong the process of dying.
How do I prepare a Health Care Treatment Directive?
1) Let your values be your guide when creating advance directives. Consider what's important to you.
Is it important to me to:
- die without pain and suffering
- be able to make my own decisions
- leave my family with good memories
- not burden my family with difficult decisions
- act according to my religious beliefs
- be with my loved ones at death
Then, ask yourself which of these statements best describes your feelings:
- It is important to me to prolong life, regardless of pain, changes for recovery and cost
- I prefer to avoid life-prolonging measures if the chances for recovery are not good
Discuss your responses with your family and friends, physician and other health care providers, religious leader and lawyer.
2) If you're ready to proceed, complete the Health Care Treatment Directive form which is available from Carondelet Health's Case Management Department or from theCenter for Practical Bioethics. Missouri State Law requires notarization of this document.
3) After signing in front of witnesses and notary, make several copies of your Health Care Treatment Directive. The directive needs to be in the medical record kept by the hospital to make sure your wishes are followed, and on file at your physician's office. Also, it's a good idea to let your family know where a copy of this important document can be found.
Durable Power of Attorney for Health Care Decisions
A Durable Power of Attorney for Health Care Decisions is a paper in which you name another person to make medical decisions for you anytime you are unable to make them for yourself. You can include instructions about any treatment you want or do not want, such as surgery, artificial nutrition, hydration (such as fluids or medicine). You can draw up a Durable Power of Attorney for Health Care with or without the advice of a lawyer. Your representative should understand and respect your health care wishes.
How do I prepare a Durable Power of Attorney for Health Care Decisions?
1) Review the Durable Power of Attorney for Health Care Decisions which is available from Carondelet Health's Case Management Department or from theCenter for Practical Bioethics. Think about any special instructions you wish to include to limit or guide your representative. Select the person you want to act as your representative. Obtain his or her consent to be your Durable Power of Attorney for Health Care Decisions. Tell him or her as directly as possible the kinds of decisions you want made on your behalf. A second alternate agent may also be named.
2) Complete the form. Missouri State Law requires notarization of this document.
3) After signing in front of witnesses and notary, make several copies of your Durable Power of Attorney for Health Care Treatment Decisions. This document needs to be in the medical record kept by the hospital to make sure your wishes are followed, and on file at your physician's office. Also, it's a good idea to let your family know where a copy of this important document can be found.
What is a Do Not Resuscitate order?
A do not resuscitate (DNR) order is a request not to have cardiopulmonary resuscitation (CPR) if your heart stops or you stop breathing. Your Advance Directives tell your doctor that you don't want to be resuscitated and a DNR order is put in your medical chart. A physician's written DNR order in your medical chart is required to honor your Advance Directive.
What if I don't have an Advance Directive?
The decision to have written directives is a very personal one. Most Advance Directives are written by older or seriously ill people as an action to reduce suffering and increase peace of mind. You should consider writing an Advance Directive even if you are in good health. An accident or serious illness can happen suddenly, and if you already have a signed Advance Directive, your wishes are more likely to be followed.
Who makes health-care decisions for me if I am unable?
1) Your guardian, if one has been appointed.
2) The person named in your Durable Power of Attorney for Health Care Decisions.
Can I change my Advance Directive?
Yes, you may change or cancel a Health Care Treatment Directive or Durable Power of Attorney for Health Care Decisions at any time. You may do this by destroying the document, putting your change in writing, or telling your doctor, nurse and family about the change. If you change your directive, you should give new copies to your family, health care providers, lawyer and others who may be involved.
What if there is a disagreement about my Advance Directive?
Your doctor and the hospital will honor Advance Directives that are in keeping with the values and mission of Carondelet Health and the standard of medical ethics. If your wishes are not able to be honored, every effort will be made to transfer your care to a facility or doctor that will.
What are life-sustaining treatments?
There are several life-sustaining treatments and medical interventions that can lengthen a person's life, delaying the moment of death. It is important your wishes be known in case you are unable to speak for yourself.
Life-sustaining treatments do not include procedures or medicine given to relieve pain. A decision to forgo life-sustaining treatment will in no way affect the care you are given to provide comfort and reduce pain. Supportive care given for comfort and pain relief will always be provided.
The following are some life-sustaining treatments:
Cardiopulmonary Resuscitation
CPR is used when a person's heart or lungs have suddenly stopped working. It usually involves chest compressions, the use of drugs and/or electric shock to restore the heartbeat, and the placement of a tube in the windpipe to maintain breathing. CPR may not be appropriate for certain patients (such as those in the process of dying due to terminal illness, those in a persistent vegetative state, or those with an incurable illness) as its use would only lengthen the process of dying.
Respirator/Ventilator
A respirator/ventilator is a machine that, by moving air into the lungs, breathes for a person who is unable to breathe naturally. Ventilators are sometimes used after a person has had surgery or when a person has an illness. The ventilator helps the person to breathe until he or she is able to do so on their own. A ventilator may not be appropriate for a patient with a terminal illness, however, because the use of a ventilator may only prolong the process of dying.
Artificial Nutrition and Hydration
Artificial nutrition and hydration are ways to provide food and fluids to a person who is unable to eat or drink. Food and/or fluids can be given directly or indirectly into the stomach (also called a "feeding tube") or through an intravenous line. These methods are commonly used when there is temporary loss of eating or digestive function. When death is certain or there is no hope of recovery, the use of artificial food and fluids may only prolong the process of dying.
Carondelet Health's policies for Advance Directives
We respect the rights and responsibilities of patients to make choices about their health care, including decisions regarding withholding and withdrawing life-sustaining treatments.
We are committed to providing you with health-care treatment information and listening to your treatment choices. You have the right to accept or refuse any medical treatment.
What is Carondelet Health's procedure on Advance Directives?
When you are admitted as a patient or come for a preadmission visit, you will be asked if you have completed a Health Care Treatment Directive or Durable Power of Attorney for Health Care Decisions. You will be offered the opportunity to complete that process while you are a patient. If you have already completed an Advance Directive, bring copies to be placed on your medical record if not already on file.
Where do I get more information?
- While at the hospital talk to your nurse or doctor. A consultation to Case Management or representative from the Spiritual Care Department can be called to assist you.
- While in the hospital, watch the video on Advance Directives on the Patient Education Channel.
- Contact the Center for Practical Bioethics
- Call the Case Management or Spiritual Care Department at St. Mary's Medical Center or St. Joseph Medical Center.
- Contact the Metropolitan Medical Society
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