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Basics of an Advance Directive

All hospitals are required to tell patients their rights under state specific laws to make decisions about their medical care at the time they are admitted to the hospital as inpatient, according to the Patient Self-Determination Act passed by Congress in 1990. These rights include the right to accept or refuse medical or surgical treatment and the right to make advance directives. Making decisions about end of life treatment and wishes, which can come at any age as a result of chronic disease, an accident or unexpected illness, can be very stressful and confusing.

An Advance Directive, also called a living will, is a legal document made by you in which you state your choices about medical treatment or name someone to make decisions about your medical care if you become unable to make these decisions for yourself. Three basic parts of an advance directive, which you may include, are appointing an agent, life prolonging treatment or procedures and making an anatomical gift following your death.

  1. You may appoint an agent (also known as a health care proxy) to make health care decisions for you if you are unable to make them for yourself. You can include instruction about specific treatment you want to accept or refuse. Appointing an agent to make health care decisions for you is a part of an advance directive which is optional. If you do not choose to appoint an agent, you cross through this option in the form for an advance directive.
  2. You can specify the kind of life prolonging medical care, if any, that you want provided, withdrawn or withheld if you become terminally ill and are unable to make your own decisions. Life prolonging treatment or procedures could keep you alive when your own body can no longer do that work and there is no reasonable hope that you will recover. Using them would take longer for you to die, but not make you better. Your "Living Will" tells your physician to provide, withdraw or withhold these treatment or procedure when you have a terminal condition. Life prolonging measures do not include pain medication or other care that gives you comfort. These would be provided to you.
  3. You may also appoint someone to make an anatomical gift or organ, tissue or eye donation on your behalf following your death.

A written advance directive must be signed, dated and witnessed. You should share a copy with your family as well as your physician, so copies can be placed in your doctor's office and hospital electronic medical record. An advance directive can be revoked at any time by rewriting, physical cancellation or destruction of the form by you, or someone in your presence and at your direction, or by oral expression of your intent to revoke. This is effective when communicated to your attending physician.

If a person does not have an advance directive and they are unable to make an informed decision about medical treatment, the physician may continue to provide, withhold or withdraw treatment if he talks with one or more persons in this order: a court appointed guardian, spouse (except where a divorce action has been filed, but not final) adult children, a parent, an adult brother or sister, nearest relative, or adult that has exhibited special care and concern for the patient – per hospital review.

Augusta Health has Preparing an Advance Directive Information and Forms packets available. For more information, please read about Advance Directives. Article provided by Dana Breeding, RN Health Educator with Community Outreach.