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Advance Directives

“Advance directive” is a term that refers to your spoken and written instructions about your future medical care and treatment. It is a collection of documents that spell out what treatments you do or do not want. These papers only discuss medical treatment and are not the same thing as legal or financial documents such as a power of attorney.
 
There may come a time when you or a family member is seriously injured or very ill and difficult decisions about giving or withholding medical care must be made. Every competent adult has the right to accept or refuse any recommended medical treatment and documenting your health care choices before you are sick or injured helps your family and physician understand your wishes.
 

Indiana Law
According to Indiana law, “competent adults have the right to control the decisions relating to their own medical care, including the decision to have medical or surgical means or procedures intended to prolong their lives provided, withheld or withdrawn.”

Under Indiana law, a written advance directive can communicate a competent person’s wishes regarding health care, including life-prolonging treatment. The directive can designate a person who will have the role of making difficult health care decisions for you, if you become unable to state your wishes. A formal advance directive can be in the form of a living will, a life-prolonging procedures declaration, an appointment of a health care representative, or an appointment of a power-of-attorney for health care (Indiana Code IC 16-8-11). You have a right to make an advance directive if you want to, but you are not required to do so.

3 Important Documents
 
  • Health Care Representative Appointment
  • Living Will Declaration
  • Life-Prolonging Procedures Declaration
Health Care Representative Appointment
As the name suggests, Health Care Representative Appointment is the form that says who will make health care decisions for you if you aren’t able. The person you choose as your health care representative will receive all information related to your illness or injury and make decisions about what treatments you will have and what treatments you won’t have.

In the health care representative appointment document, you may also choose an alternate representative. This person would step in and make your medical decisions if the first person can’t or won’t make them.

In some states you can name people who under no circumstance will be allowed to make medical decisions for you. People on this list should not be those you are mad at, but rather people who aren’t qualified to make medical decisions, do not share your personal beliefs, or those who would intentionally go against your wishes.
 

Living Will Declaration
A “living will” is the name given to your decisions regarding end of life care. These decisions include the specific care and treatment you want or do not want if you are diagnosed with a terminal illness. Examples include directions for CPR, artificial nutrition, blood transfusions, and use of a respirator.
 
The Living Will Declaration tells your doctor and family that if your death is expected in a short time, you do not want death artificially prolonged and wish to die naturally. This document includes consent for medical procedures or medication necessary to provide you with comfort care or to alleviate pain. It also lets you decide if you want artificial nutrition and hydration.

 
Life-Prolonging Procedures Declaration
The Life-Prolonging Procedures Declaration is the opposite of a living will. You fill out this document if you want all life-prolonging medical treatments used to extend your life. This includes:
 
  • Appropriate nutrition and hydration
  • Medication
  • Medical procedures
There are specific instructions on who can witness a Living Will Declaration and a Life-Prolonging Procedures Declaration. Generally, immediate family, financial beneficiaries and health care providers cannot sign these documents as a witness. The law is slightly different in each state, so take the time to read the fine print. 
 
 
A living will (Living Will Declaration or Life-Prolonging Procedures Declaration) does not become effective until three conditions are met.
 
  1. The patient has been diagnosed with an incurable injury, disease or illness.
  2. A physician has certified in writing that the patient is in terminal condition—meaning   there can be no recovery, and death will occur within a short period of time.
  3. That life-prolonging procedures would only prolong the dying process.

A living will may be revoked at any time by a signed and dated revocation, physical cancellation such as destroying the living will, or by telling others that it is being revoked. If the living will is revoked, the physician must be told.

In the instance that the patient is pregnant, a living will is not valid.
 

Additional types of advance directive forms
 
  • Psychiatric Advance Directive
  • Out-of-hospital “Do Not Resuscitate” Declaration and Order
  • Physician Orders for Scope of Treatment (POST)
  • Power of Attorney
These documents relate to more specific patients and patient conditions. Some of these documents also require the assistance of an attorney. If you have questions or would like more information on these documents, please contact the Religious Life Department. We will connect you with the resources needed.

How to complete a living will:
 
  1. Obtain the form appropriate for Indiana. A copy may be obtained by contacting a personal attorney, the Indiana Bar Association, the Society for the Right to Die/Concern for Dying or the American Association of Retired Persons.
  2. The basic form may be modified or expanded to meet the specific needs or health care desires of an individual. Persons wishing to modify the form are encouraged to speak to an attorney.
  3. Within a hospital environment, a patient should date and sign the living will and have it properly witnessed. Although it is not illegal to do so, health care workers providing care to the patient should not act as witnesses due to the possible conflict of interest.
  4. A copy of the living will should be placed in the patient’s medical record upon admission, and the patient should distribute copies to his/her physician, attorney and close family members.
  5. A copy of the living will should be presented each time the person is admitted to a hospital so that it may be entered into the medical chart for that particular admission.
  6. Hospital personnel are encouraged not to try to answer any questions with legal implications. If questions arise, the patient is encouraged to contact his/her personal attorney. The hospital risk management department is also available for consultation.
Deaconess serves the entire tri-state area and we honor advance directives from all three states (KY, IN, IL). However, if you do not have an advance directive, we will go by the Indiana laws

Sample Forms
  For more information, refer to the Put It In Writing website offered by the American Hospital Association.
 

What If You Change Your Mind?
You can revoke or amend your advance directive at any time. You should inform your physician, attorney, nurse or relative of your decision to make changes in any of these documents.


Ethics Committee
It is difficult for people to make decisions when they are under great stress or emotional strain. It can be even more difficult when there are no clear-cut answers as to what is best for the patient. These matters often require discussion and careful thought.

If you experience difficulty in making a decision, the hospital has an Ethics Committee, made up of health care professionals and community members, to review specific situations. This committee can help you understand treatment options without requiring you to follow its recommendations. Your physician or nurse can help you contact an Ethics Committee representative.


Questions?
Contact the Religious Life Department at 812-450-2260.
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