Advanced Directives

1. Advanced Directives Facing End-of-Life Decisions With a Plan

2. What is an Advance Directive? • Formal advance directives are documents written in advance of serious illness that state your choices for health care, or name someone to make those choices, if you become unable to make decisions. • Through advance directives, such as living wills and durable powers of attorney for health care, you can make legally valid decisions about your future medical treatment.

3. WHY IS THERE SO MUCH INTERESTIN ADVANCE DIRECTIVES NOW? • Growing ability of medical technology to prolong life • Highly publicized legal cases involving comatose patients whose families wanted to withdraw treatment. • Many people want to avoid extending personal and family suffering • Family feuding • Family uncertainty • Financial burdens on family • The easiest way to retain control in such situations is to record your preferences for medical care in advance and share your decisions with your key people such as your physician, loved ones and clergyperson

4. What is a Durable Power of Attorney for Health Care? • By executing a power of attorney for health care, you are authorizing someone to make health care decisions on your behalf. • It is a signed, dated, and witnessed document naming another person to be your agent in making health care decisions when you no longer can. • Your power of attorney for health care may ONLY make medical decisions for you • if you are unable to make them for yourself • at any time, not just at the end of life. • It is not the same as a power of attorney for financial matters

5. What is a living will -- sometimes known as the “Iowa Declaration”? • A living will is a document in which you can stipulate the kind of life-prolonging medical care you want if you become terminally ill, permanently unconscious, or in a vegetative state and . . . • You are unable to make your own decisions • It informs medical personnel that you do not want certain life-prolonging medical procedures if you may die soon. • It helps your durable medical power of attorney, as well as family and loved ones, understand your wishes. • Your durable medical power of attorney has the prerogative of overriding your living will.

6. More Definitions • Health care means • any care, treatment, service or procedure, that is meant to • maintain, • diagnose or • treat an individual’s physical or mental condition. • Health care decisions mean • the consent, • The refusal to consent, or • withdrawal of consent to health care.

7. Who Should Have a Copy of My Advance Directives? • Your Durable Power of Attorney for Healthcare • Your physician • The ER • Your Pastor or Clergy Person • Others

8. When may I change or revoke my advance directives? • At any time! • It is important to review your documents periodically • to ensure they are consistent with your current values and • so that they are consistent with current medical technology. • If you have a living will that was made prior to April 23, 1992 review it regarding your wishes for hydration and nutrition.

9. Does having living will or power of attorney for health care affect my life insurance? No. Insurance companies may NOT require you to have advance directives

10. If I have a living will and life sustaining procedures are not provided, can my death be legally considered a suicide or homicide? No

11. Durable Power of Attorney for Health Care

12. Who shall I choose to be my durable power of attorney for health care decisions? A family member or friend who: • is at least 18 years old • knows you well • can be there for you when you need them • you trust to do what is best for you • can tell your doctors about the decisions you made on this form • Your agent cannot be your doctor or someone who works at your hospital or clinic, unless they are a family member.

13. Who may NOT be my power of attorney for health care? • Your health care provider • An employee of your health care provider • Unless related to you by blood, marriage, adoption • Under the age of 18

14. What kind of decisions can my power of attorney for health care make? • Agree to, say no to, change, stop or choose: • doctors, nurses, social workers • hospitals or clinics • medications or tests • The use of various life sustaining machines • what happens to your body and organs after you die

15. Who will make decisions if I don’t have a power of attorney for health care? In the following order • My court appointed guardian (with court approval) • My spouse • My adult child or, if more than one, the majority of my children • My parent or parents • My adult brother or sister

16. Your Agent May have to consider (in consultation with your living will): • Life support treatments – medical care to try to help you live longer, but that will not cure you • CPR or cardiopulmonary resuscitation. This may involve: – pressing hard on your chest to keep your blood pumping – electrical shocks to jump start your heart – medicines in your veins • Breathing machine or ventilator • The machine pumps air into your lungs and breathes for you. • You are not able to talk when you are on the machine.

17. Your power of attorney may have to consider (in consultation with your living will): • Dialysis • A machine that cleans your blood if your kidneys stop working. • Feeding Tubes • A tube used to feed you if you cannot swallow. The tube is placed down your throat into your stomach. It can also be placed by surgery. • Blood transfusions • To put blood in your veins. • Surgery • Medicines

18. Your power of attorney for health care may ensure you have adequate end-of-life care: • if you might die soon your health care agent can: • Call in a spiritual leader • Decide if you die at home or in the hospital • Call for a hospice referral • Other _______________

19. Living Wills General living wills and those that are more specific

20. If I sign a general living will what does “Life-prolonging” mean? • The use of artificial/mechanical means to sustain or restore life when physicians determine your condition is terminal • nutrition and hydration • nutrition and hydration are considered “life prolonging” if they are given through a tube. • food and water will be offered, but will not be given through a tube if death is immanent and you have signed a general living will. • Medication or procedures to limit pain or give comfort • These not considered life-prolonging. It will be assumed you want these.

21. May I have more than a general living will? • Yes! • You may be as specific as you like regarding your wishes for end-of-life care. The more specific you are the easier it is for people to make decisions regarding your care. • Some forms prompt you for specifics, others simply leave room for specifics.

22. What might I ask myself when I am considering a living will? What should I talk over with my loved ones?

23. My life is only worth living if I can: • talk to family or friends • wake up from a coma • feed, bathe, or take care of myself • be free from pain • live without being hooked up to machines • Other:_____________________________ • My life is always worth living no matter how sick I am

24. If I am dying, it is important for me to be: • At home • In a nursing home • in the hospital • I am not sure

25. What should my doctors know about my religion or spirituality? • Particular prayer or sacramental desires? • Dietary requests? • Modesty requests? • Rituals upon illness or death? • Who can touch your body, when? • Other?

26. If I am so sick that I could die I want my doctors to: • Try all life support treatments that my they think might help. • If the treatments do not work and there is little hope of getting better, I want to stay on life support machines. • Try all life support treatments that my doctors think might help. • If the treatments do not work and there is little hope of getting better, I do not want to stay on life support machines.

27. If I am so sick that I could die I want my doctors to: • Try all life support treatments that my doctors think might help but not these treatments: • feeding tube • CPR • dialysis . blood transfusion • breathing machine . medicine • other treatments_____________________________________ • I want ____________ only if ___________. • I do not want any life support treatments. • I want my health care agent to decide for me.

28. Am I interested in donating (giving) my organs so that they may help save lives? • I want to donate my organs • Which organs do you want to donate? • any organs • only_____________________________________ • I do not want to donate my organs. • I want my health care agent to decide.

29. Would I want an autopsy performed on my body after I die? • An autopsy can be done after death to find out why someone died. • Some family members may want an autopsy in order to know more about their genetic risks • It is done by surgery. It can take a few days. • Options may be: • I want an autopsy. • I do not want an autopsy. • I may want an autopsy if there are questions about my death. • I want my health care agent to decide.

30. A Few Additional Questions to Ponder: • What do you value most about your physical and/or mental wellbeing. • What are your fears regarding serious illness or end of life? • Would you want to be sedated if it were necessary to control your pain, even if it makes you drowsy or puts you to sleep much of the time? • Would you want a hospice team or other palliative care available to you? • If you could plan today, what would the months of your life look like? Last weeks? Last days? • How do you want to be remembered? • Would you consider an ethical will?