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Advance Directives: What you need to know

Southeast Hospital has two forms available to you for Advance Directives:

Both require the free Acrobat Reader to access these printer-friendly PDFs.
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What are Advance Directives?

Advance directives can be a living will or a durable power of attorney for health care -- either document allows you to give directions about your future medical care. Advance directives protect your right to accept or refuse certain kinds of medical care should you ever become mentally or physically unable to communicate your wishes due to an accident or serious illness.

What kinds of rights do patients have?

Patient rights include privacy; informed consent (a clear explanation of advantages and risks of any procedures, tests or treatments); information about your condition; and information about advance directives.

Why is there so much interest in advance directives now?

Many people today are concerned about the medical care they would be given if they should become terminally ill and unable to communicate, partly because of the growing ability of medical technology to prolong life and partly because of highly publicized legal cases involving unconscious or dying patients. Many people don't want to spend months or years dependent on life-support machines, and they don't want to cause unnecessary emotional or financial distress for their lived ones. But without advance directives, they have little or no choice in the treatments they receive.

What does the law say about this issue?

Laws differ from state to state, but in general a patient's expressed wishes will be honored. The Patient Self-Determination Act now requires all hospitals participating in Medicare or Medicaid to ask all adult inpatients if they have advance directives, to document their answers and to provide information on state laws and hospital policies regarding advance directives.

How are durable power of attorney for health care and living wills different?

Living wills are written instructions that explain your wishes regarding health care, should you have a terminal condition. They're called "living" wills because they take effect while a patient is still alive. The living will must be signed in the presence of two witnesses who are 18 or older. A notary public is not necessary. Durable power of attorney allows you name to a person to make decisions for you if you become unable to do so. You can specify which decisions your representative can make about health care. Durable power of attorney for health care must be signed by the individual and two witnesses, and it must be notarized. The Missouri statute prohibits living will requests for withdrawal of nutrition and hydration once it has been initiated. Durable power of attorney for health care provides for withdrawal of nutrition and hydration if the individual so desires.

How can people determine which procedures they would not want to prolong life?

When creating advance directives, let your values be your guide. Although it isn't possible to specify every possible procedure under every possible circumstance, it is possible to decide what kind of treatment would be preferable in most situations. For example, advance directives may enable you to make your feelings known about cardiopulmonary resuscitation; artificial nutrition and hydration; respirators (breathing machines); kidney dialysis; and the use of medications for pain relief.

Are living wills and health care power of attorney irrevocable?

No. These documents may be changed or revoked at any time. Any alternations or revocations should be signed and dated, with copies given to your family, your physician and your attorney. But even without an official written version, your orally expressed directions to your physician generally have priority over any statement made in a living will or power of attorney as long as you have the ability to make decisions and communicate effectively.

Can a patient's relative prevent advance directives from taking effect?

Generally, no, unless the relative can prove the patient was not thinking clearly when he or she created the living will or advance directive.

If a comatose or mentally incompetent patient doesn't have a living will or durable power of attorney, who decides what to withdraw treatment?

If that patient has not made any advance directive, the decision is left to the family, the physician, the hospital and sometimes a court of law.

Where can I get more information about advance directives and living wills?

Living wills are available through Southeast Hospital's Pastoral Care (651-5519) or Social Services (651-5549) departments. You can also click on the PDF forms above for the Hospital's Durable Power of Attorney for Health Care Decisions and the Missouri Bar Association's Durable Power of Attorney for Health Care and Health Care Directive.