You are here: Deaconess Hospital > About Us > Patient Pre-Registration > Advance Directives

Advance Directives

What Is an Advance Directive?

An Advance Directive is a legal document written in advance of an incapacitating illness. The document may state your wishes for medical treatment, or it may appoint a person to make medical decisions for you. Instructions specified in your Advance Directive will be followed if you become unable to make decisions about medical treatment.

Learn more below about:

For more information, refer to the Put It In Writing Web site offered by the American Hospital Association.

How Do I Create an Advance Directive?

Deaconess Hospital offers sample forms below. Ideally, you should seek legal counsel when creating an Advance Directive. An attorney can provide detailed information about the types of Advance Directives you may wish to create and the issues you should address in each document. Your Advance Directives must be signed, dated and witnessed by two people who know you well and are at least 18 years old.

Witnesses should not be related to you, be potential heirs, hold direct financial responsibility for your health care, or be your personal health care provider.

What Should I Do After Creating an Advance Directive?

We encourage you to discuss and share your Advance Directives with your family members and physicians. Additionally, bring a copy of your Advance Directives every time you are hospitalized or undergo surgery.

Types of Advance Directives

Deaconess offers sample forms for the advance directives listed below. We encourage patients to contact an attorney if they want to document wishes that are not addressed in the samples.

Living Will - This document allows you to specify or limit the kinds of life-prolonging procedures you wish to receive if you become unable to make medical decisions. You may voice your wishes about:

  • CPR, if cardiac or respiratory arrest occurs
  • Artificial nutrition, through intravenous or tube feedings
  • Prolonged maintenance on a respirator, if unable to breathe adequately on own
  • Blood cultures, spinal fluid evaluations, and other diagnostic tests
  • Blood transfusions

Please note that a Living Will is different from a Last Will and Testament that distributes assets after a person's death.

Life Prolonging Procedures Declaration - This document allows you to specify your wish to receive life-prolonging procedures that would extend your life if you become terminally ill and are unable to make medical decisions.

Appointment of Health Care Representative - This document allows you to name someone else to make health care decisions for you if you become unable to make health care decision. If you appoint a Health Care Representative, you should inform this person of your wishes regarding withholding or withdrawal of care, as well as matters of more routine care. This form of Advance Directive can relate to any medical situation, not only terminal illness.

Psychiatric Advance Directive - Any person may make a psychiatric advance directive if he/she has legal capacity. This written document expresses your preferences and consent to treatment measures for a specific diagnosis. The directive sets forth the care and treatment of a mental illness during periods of incapacity. This directive requires certain items in order for the directive to be valid. Indiana Code 16-36-1.7 provides the requirements for this type of advance directive.

Sample Forms

Click here for help in downloading
Adobe Acrobat Reader