Advanced Medical Directives

Every adult of sound mind has the right to decide what may be done to his or her body in the course of medical treatment. As a patient, you have the right to be told about the nature of your condition, the nature of the proposed treatment and alternative procedures that are available. This information is provided in order to allow you to make an informed and rational decision on accepting or declining a course of treatment.

You may of course request a second opinion. You cannot be penalized in any way for choosing to request a second opinion or refusing a certain course of treatment.  In other words, the hospital cannot dismiss you if you wish to consult another doctor.

You may at any time sign a directive to physician or Living Will.  You may sign a Directive to Physicians concerning your care if you are at least 18 and of sound mind and you are acting of your own free will in the presence of 2 qualified witnesses.

This directive also referred to as a living will, instructs your physician not to use artificial methods to prolong the process of dying if you are terminally ill. NOTE -- this directive does not become effective unless you are diagnosed and certified in writing to have a terminal condition.  This form should be in your medical records.  You will also want to have a copy with whom ever you designate as your Agent. The original of the directive should be kept at your home. You may make an oral directive to your physician if you are terminal and unable to sign.

If you do not have a living will and you become comatose or otherwise unable to communicate after being diagnosed with a terminal condition, your physician and legal guardian or certain family members in the absence of a legal guardian can make decisions concerning withholding or withdrawing life-sustaining treatment.

Out-of-Hospital Do Not Resuscitate Order (OOH DNR)

The OOH DNR allows you to decide, if diagnosed with a terminal disease by a physician, that you do not want to be resuscitated if you stop breathing and your heart stops beating outside of a hospital. In Texas (my home state) the resuscitative measure specifically listed are cardiopulmonary resuscitation (CPR), advanced airway management, defibrillation, artificial ventilations, and transcutaneous cardiac pacing.  Check with your local hospital for specifics to your state. The DNR must be visible to any emergency personal.

Durable Power of Attorney for Health Care General Information

This document, signed by a competent adult, designates someone you trust as an agent to make health care decision on your behalf should you become unable to make such decisions.

Agents

Almost anyone can be your agent with the exception of

• your healthcare provider
• an employee of your health care provider, unless that person is a relative
• your residential care provider (nursing home, hospice, or other licensed residential care home
• an employee of your residential care provider unless that person is a relative

The authority of an Agent

An agent can make health care decision on your behalf only when your attending physician certifies in writing, based on reasonable medical judgment, that you lack the capacity to make your own healthcare decisions.  This certification must be filed in your medical records.

Your agent cannot make a health care decision if you object regardless of whether you have the capacity to make the health care decision yourself or whether a Durable Power of Attorney for Health Care is in effect.

Your agent shall make healthcare decision after consultation with your attending physician and according to his or her knowledge of your wishes, to include your religious and moral beliefs.

Your physician shall comply with your agent's instructions as permitted by law, ethics and good medical practice or allow you to be transferred to another physician.

Legal Aspects of Advance Directives

Neither the Directive to Physicians, the Durable Power of Attorney for Health Care nor the OOH DNR needs to be notarized in order to be a legally valid expression of your desires.  No hospital may require you to fill out any of these forms as a condition for admittance.

Any time you go to the hospital you must take a copy of any of your directives and you should inform the admitting clerk, and nurses and physicians involved in your care that you have these directives.

We all know we are invincible so it is hard to do certain things such as make a will or fill out an advance directive form.  Someday, someone will indeed need those documents.  Please don't put it off until it is too late for you to express your desires.