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Advance Directives (or living will)Choosing Your Care When you need medical care, you have the right to make choices about that care. But there may come a time when you are so sick that you can’t make your choices known. You can stay in charge by putting your choices in writing ahead of time. This is called giving advance directives. What is an advance directive? Under most State's laws, any spoken or written decision or instruction about the healthcare you want in the future is called an advance directive. You can tell your doctor or family what you want. But it’s best to write it down. Advance directives also are sometimes called living wills or durable healthcare powers of attorney. If you have already signed such a document, be sure your doctor, your hospital, and your family have copies. If you have not signed a form, you may use the healthcare advance directive attached here. But you don’t have to. Who can complete an advance directive? Anyone living in a State who is 19 years of age or older can complete an advance directive. If you are younger than 19, you may also be able to complete an advance directive under certain limited circumstances. How does an advance directive help? If you sign an advance directive, your family and your doctor will know who to talk to about your care or what kinds of treatment you want or don’t want if you are too sick to decide. This could happen if you have a serious illness, are near the end of life, or are no longer aware. If doctors don’t know your wishes, they will treat you until they can ask your family what you want. If your family doesn’t know, you may get treatments you don’t want or that you would stop if you had your way. In an emergency, you will receive care until doctors can determine your condition and what your wishes are. If you do not have an advance directive, State law allows your doctors to ask your relatives, and perhaps others close to you, to make decisions about your care, as explained on the next pages. What do I choose in an advance directive? The form link below allows you to do five things: 1. Choose someone to make all your healthcare decisions beginning either right away or when you are too sick to decide. That person is called your agent. Your agent can be a family member or friend. If you choose an agent, two (2) witnesses must sign your advance directive. 2. Choose whether or not you want certain treatments when you are no longer aware, very ill or may not live. For example, you can choose what you wish to have done if you are dying, or if you are in a permanent coma. Your agent must follow any choices you make in an advance directive. 3. State a desire to donate your organs. (Your family will make the final decision, but this will tell them your wishes.) 4. Name your primary doctor. 5. State your wishes or name someone to decide funeral and burial wishes. What happens if my heart stops in the hospital or nursing home? If your heart or breathing suddenly stop in the hospital or nursing home, drugs, machines, and other means will be used to try to restart them. This is called cardiopulmonary resuscitation, or CPR. CPR is always done unless your doctor writes an order called a “Do Not Resuscitate” order, or DNR. If you have concerns about CPR, discuss them with your doctor while you are well. If you make an advance directive that says you do not want CPR, it may not be possible for the hospital or nursing home to follow your decision. For example, if you come to the emergency room and your heart has stopped, there may be no time to check your advance directive before CPR is started. If you do not want CPR while you are in the hospital or nursing home, your doctor must write a DNR order for you and put it in your medical record. What happens if my heart stops at home? If you are at home and your heart stops, ambulance crews may still give you CPR even if you have an advance directive. You should talk with your doctor if you do not want CPR at any time. If you and your doctor both sign a special form then your decision not to have CPR should be followed. Show that form to those close to you and keep it where it will be easily seen. Your doctor will then give you a special bracelet or wallet card designed to alert ambulance crews that you do not want CPR. When does my advance directive go into effect? You can fill out the form in either of two ways to decide when it goes into effect. You may want your advance directive to be used only when you are too sick to choose your care or tell others what you want. If you fill out the form this way, your doctor will decide when the form goes into effect. Or, you may fill out the form so your agent can make those decisions right away, but you will still be told about them. Who will decide my care when I’m too sick to choose if I don’t have an agent or an advance directive? If you do not name an agent or do not have an advance directive, the doctor will ask your family what treatment you would want, in this order: your spouse (unless legally separated), someone with whom you share an emotional, physical, and financial bond similar to that of a spouse, your adult children, your parents, your adult brothers and sisters, your adult grandchildren, your adult nieces and nephews, your adult aunts and uncles. If there are family members whom you do not want to make decisions for you, you need to put this in writing and give it to your doctor or hospital. If the doctor can’t reach a family member, the doctor may ask another adult relative or good friend who knows your values. What happens if I do not make an advance directive? Your family can tell your doctor to continue to treat you. They can also tell your doctor to stop or not give treatment to keep you alive (life-sustaining treatment) if you are dying or in a permanent coma. They may also make some other decisions for you if you are no longer aware and there is no guardian or advance directive, but no one may deny surgery or procedures to save your life if your doctor thinks they are necessary. Does my doctor have to follow my choices? Yes. If your doctor, hospital, or other place of healthcare has any special rules about healthcare decisions, or if they will not carry out your decisions, they must tell you. They must then arrange to move you to a doctor, hospital, or other facility that will carry out your decisions. What if I suffer from a mental health problem? You may also choose to sign a different form, called a mental health directive, that allows you to choose what treatment you want if you become very mentally ill and are unable to make healthcare decisions. What rights do I have as a patient? When you need medical care, you have certain rights, including the right to refuse care. You have a right to know: • what your medical problem is and what tests and treatments may be needed; • what the doctor thinks can be done and what the usual risks may be; • whether there are other ways to care for you; • what may happen if you refuse care. What else should I know? Every hospital, nursing home, and many other places that provide healthcare in a State have these forms or can tell you how to get them. Just ask your doctor or nurse. They can explain the forms, but they cannot give you legal advice. 2 No one can make you sign a form or stop you from signing it. You also have the right to change or cancel a form at any time. It does not allow anyone to violate laws against mercy killing and euthanasia. If you have a complaint about how a hospital or other place of healthcare handled your advance directive, you can contact: the Licensing Division In your State's Department of Human Services. The advance healthcare directive form does not allow others to control your money or property. To appoint someone to control your money and property, you need a different form- a financial power of attorney and you should discuss that with your lawyer. What happens next? This form should be applicable at any hospital. Typically, a hospital will place a copy of your advance directive in your medical record. Hospitals we will tell your doctor and other caregivers that your advance directive is in your record, and the care they give you will follow your advance directive, if you are ever unable to make medical decisions for yourself. You are not required to have an advance directive. If you wish, we will help you make an advance directive by giving you the Hospital Association’s advance directive form. You may use another advance directive form if you prefer. The hospital and your doctor will follow your advance directive unless following it would not be good medical care. Make sure to tell people. Tell your family members, doctors, and others close to you what you have decided. You should talk to the agent(s) you have chosen to make sure that they understand your wishes and are willing to carry them out. Give a copy of this form to your doctor, to any other healthcare providers you have, to any place where you get health care, and to any agents you have chosen. Please be sure to list on the front page the people who have copies. Click on and print out the link below and then complete the form. The link to the Advanced Directive form is here (click) >>
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