Individuals usually make decisions regarding their healthcare treatment after their physician recommends a course of treatment and provides information about the treatment. Through documents, known as Advance Directives, individuals can express their treatment preferences before they actually need such care, ensuring that their wishes will be carried out and their families will not be faced with making these difficult decisions.
All patients will be presented with Advanced Directives at the time of admission, and will be asked to fill out paperwork and provide a signature to the following documents.
What is an Advance Directive?
“Advance Directives” are the documents written in advance of the time when you are unable to make healthcare decisions for yourself. You have a right to make important legal decisions in advance about your healthcare. By law, the lack of Advance Directives does not hamper your access to care. Abrazo Health employees and the physicians who practice within the system will abide by your advance directives in accordance with the law.
An Advance Directive may be set-aside during invasive procedures when a patient is under anesthesia or sedated. This means that if you are having a surgical procedure or a procedure that requires anesthesia or sedation your directive will be set aside (ignored) until such time that you have completed the procedure.
Here is some general information on the four types of Advance Directives recognized under Arizona law.
Directive to Physicians and Family or Surrogates (Living Will)
A Directive to Physicians and Family or Surrogates, also known as a “living will,” allows you to tell your physician not to use artificial methods to prolong the process of dying if you are terminally ill. A Directive becomes effective only after you have been diagnosed with a terminal or irreversible condition.
If you sign a Directive, talk it over with your physician and ask that it be made part of your medical record. If for some reason you become unable to sign a written Directive, you can issue a Directive verbally or by other means of non-written communication, in the presence of your physician.
If you have not issued a Directive and become unable to communicate after being diagnosed with a terminal or irreversible condition, your attending physician and legal guardian, or certain family members in the absence of a legal guardian, can make your decisions concerning withdrawing, withholding or providing life-sustaining treatment. Your attending physician and another physician not involved in your care also can make decisions to withdraw or withhold life-sustaining treatment if you do not have a legal guardian and certain family members are not available.
Directive to Physicians and Family or Surrogates (Living Will):
Medical Power of Attorney
Another type of advance directive is a Medical Power of Attorney, which allows you to designate someone you trust – an agent – to make healthcare decisions on your behalf should you become unable to make these decisions yourself.
The person you designate must be an adult. You may select a member of your family, such as your spouse, child, brother or sister, or a close friend. If you select your spouse and then become divorced, the appointment of your spouse as your agent is revoked. The following people cannot be appointed as your agent: your treating healthcare provider, an employee of your healthcare provider, unless he or she is related to you; your residential care provider or an employee of your residential care provider, unless he or she is related to you.
The person you designate has authority to make healthcare decisions on your behalf only when your attending physician certifies that you lack the capacity to make your own healthcare decisions. Your agent cannot make a healthcare decision if you object, regardless of whether you have the capacity to make the healthcare decision yourself, or whether a Medical Power of Attorney is in effect.
Your agent must make healthcare decisions after consulting with your attending physician, and according to the agent’s knowledge of your wishes, including your religious and moral beliefs. These decisions can include authorizing, refusing or withdrawing treatment, even if it means that you will die. If your wishes are unknown, your agent must make a decision based on what he/she believes is in your best interest.
Texas Law prohibits your agent from consenting to voluntary inpatient mental health services, convulsive treatment, psychosurgery, abortion, or omitting care intended primarily for your comfort.
Medical Power of Attorney:
Out-of-Hospital Do-Not-Resuscitate (DNR)
An Out-of-Hospital DNR Order allows you to refuse certain life-sustaining treatments in any setting outside of a hospital. Among these settings are Home Health, Hospice, Nursing Homes, Ambulances, and Hospital emergency rooms. This Advance Directive must be issued in conjunction with your attending physician and signed by two witnesses on an orange sheet of paper.
Out-of-Hospital Do-Not-Resuscitate (DNR):
Declaration for Mental Health Treatment
Another type of Advance Directive deals with mental hospital treatment only. A Declaration for Mental Health Treatment allows you to tell healthcare providers your choices for mental health treatment, in the event that you become incapacitated.
Unlike the living will and medical power of attorney which do not expire, the DMHT expires 3 years from the date that you sign it. If you are incapacitated on that date, the document continues in effect until you are again able to make your own decisions.
Declaration for Mental Health Treatment:
If you become unable to make your own healthcare decisions and do not have a legal guardian or someone designated under a Medical Power of Attorney, then certain family members and others can make medical treatment decisions on your behalf.
Legal Aspects of Advance Directives
An Advance Directive does not need to be notarized. Neither this hospital nor your physician may require you to execute an Advance Directive as a condition for admittance or receiving treatment in this or any other hospital. The fact that you have executed an Advance Directive will not affect any insurance coverage that you may have.
Patients and families may participate in ethical questions that arise in the course of care, including issues of conflict resolution. The Abrazo Health System has a formal process in place to address ethical issues and dilemmas in your care. Should you or your family desire an ethics consultation, please ask your nurse to contact the Hospital Ethics Consultation Team.