What Are Advance Medical Directives?

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1 What Are Advance Medical Directives? UAMS would like you to know there are ways to let others know what decisions you would want to make about your medical treatments, even when you are unable to speak for yourself. There are two forms you can complete that will make your wishes known. A Durable Power of Attorney for Health Care and or a Living Will. These forms are known as Advance Directives. What Are Advance Medical Directives? A Durable Power of Attorney for Health Care names a Health Care Agent to make medical decisions for you. This person will then be the legal medical decision maker for you if you cannot speak for yourself. A Living Will tells your physicians what you do and do not want concerning treatments if you become terminally ill and unable to speak for yourself or if you become permanently unconscious. Your Living Will may also allow your Health Care Agent to make decisions about life-sustaining treatments for you if you are unable to make these decisions for yourself. Every state makes its own laws concerning advance directives. In Arkansas, a Living Will only becomes effective if you are dying or permanently unconscious and you lose the ability to make and communicate your decisions. A Durable Power of Attorney for Health Care generally only allows your Health Care Agent to make medical decisions for you if you lose the ability to make and communicate your decisions. However, if you choose to do so, you may add specific language to the document to allow your Agent to make decisions for you even if you are still able to do so yourself. It is a good idea to have an Advance Directive since accidents and illness can strike at any time. It is your right to accept or refuse medical care, and an Advance Directive helps us follow your wishes and can protect you if you become mentally or physically unable to choose or tell someone your wishes. Deciding What You Want Thinking about end-of-life care can be emotional. Before completing either a Durable Power of Attorney for Health Care or a Living Will, it can be helpful to start by thinking about what is important to you. Then you can decide the level of care you would want. Advance Directives can help you protect your right to make medical choices, help your family avoid the stress of making hard decisions, and help your doctor by giving him or her guidelines for your care.

2 Advance Medical Directives, continued (Page 2 of 7) Recording Your Wishes Once you know what kinds of medical care you may want, you can express and protect your wishes by putting them in writing. Types of Advance Directives: Living Will: A written document that explains your wishes for your healthcare if you have a terminal condition or become permanently unconscious Durable Power of Attorney for Healthcare: A written document that names a person to make healthcare decisions for you if you are unable to make and communicate decisions for yourself Taking Steps to Making Your Wishes Known There are four (4) basic steps to developing an Advance Directive. Each one is discussed below. Step 1: Clarifying What Is Important To You End-of-life decisions are actually decisions about how you want to live. Thinking about the questions below and talking about them with family and friends can be helpful: What do you fear most about being ill or injured? How much do you value being able to do things on your own? How much do you value physical activity? How would you feel if you could no longer do things that you currently enjoy? How important is it for you to be physically, mentally or financially independent? How would you feel about being cared for in a place other than your own home for example, in a hospital or nursing home at the end of your life?

3 Advance Medical Directives, continued (Page 3 of 7) Step 2: Learning about End-of-Life Treatments A Living Will can be written to explain what treatments you wish to have or those you wish to limit should you be unable to make and communicate decisions for yourself. Should decisions about lifesustaining measures have to be made, a Living Will, can help make sure your wishes are known. Some treatments to consider are: Cardiopulmonary Resuscitation (CPR) Special measures used by doctors and nurses to restart the heart when it stops beating (This may include pushing on your chest, giving medicine, or using electrical shock.) Intravenous (IV) Therapy Medications or fluids given through a tube placed in a vein Feeding Tubes (Artificial/Assisted Nutrition) Using a tube that goes into your nose, belly, or intravenously (through a vein) to give food or liquid to patients who are unable to swallow on their own Ventilators (Artificial/Assisted Breathing) Using a machine (a ventilator) to help you breathe or to breathe for you when you can t Sometimes a ventilator can be used with a mask (which does not require a tube to be inserted in your body), but most times, patients require intubation (a tube inserted in your wind pipe or through a hole in your neck). The treatments listed above are not the only treatments that you might want to think about. Talk with your doctor about other types of treatments and the circumstances where these treatments would apply. Your Advance Directive can explain the treatments that you wish to be started, as well as those you wish to be withheld or stopped. You can even state that you would like a treatment to be started, but stopped at a later time if it is not helping you to recover. Step 3: Creating an Advance Directive Any competent (someone able to think clearly and understand) adult and any emancipated minor can create an Advance Directive. Parents can create Advance Directives for their minor children. You can be as specific as you want. You can create both a Living Will and a Durable Power of Attorney for Healthcare. Sign and date your Advance Directive. Advance Directives must either be notarized or witnessed by two competent adults. At least one of the witnesses cannot be related to you by blood, marriage or adoption, or entitled to any part of your estate. Neither witness can be the person you designate as your Health Care Agent. If you name your spouse as your Health Care Agent and later divorce or legally separate, your spouse will no longer be your Agent unless your Advance Directive specifically states otherwise. [Note: While state laws on Advance Directives may differ, if you have created a valid Advance Directive in another state, it will also be accepted in Arkansas.]

4 Advance Medical Directives, continued (Page 4 of 7) Step 4: Making Sure People Know about Your Advance Directive It is a good idea to keep a card in your wallet stating that you have Advance Directives and where to find them. Give your doctor a copy to be kept as part of your medical records. Give copies to relatives and friends who might be called in an emergency. If you use a Living Will, explain your reasons for your instructions to your doctor and your family and friends. Let them know why you do or do not want particular treatments at the end of life. If you designate a Health Care Agent to make healthcare decisions for you, be sure to give that person a copy and let him or her know why you do or do not want particular healthcare treatments. Review your Advance Directive regularly and make changes if needed. Tell your doctor, family, and friends about any changes you make. Some Questions and Answers about Advance Directives: 1. When will an Advance Directive be used? A Living Will only has authority to speak for you when you can t or you are dying or permanently unconscious and will not get better. Unless otherwise specified, a Durable Power of Attorney for Health Care will only be used if you are unable to make and communicate decisions for yourself. This authority goes away as soon as you regain the ability to make decisions and speak for yourself. 2. Must a doctor follow my advance directive? Yes, your doctor must follow your Advance Directive. If he or she is unable to, then he or she is required to try and transfer your care to a doctor who can.

5 Advance Medical Directives, continued (Page 5 of 7) 3. What if I change my mind? You can change or cancel your Advance Directive at any time, by telling us or writing it down. You can change who you want to be your Health Care Agent by making the change in writing or by completing a new Health Care Agent form. Make sure you tell your doctors, health care workers, hospital, and friends that your wishes have changed. Ask them to tear up and destroy old copies. 4. Are fluids and nutrition considered life-sustaining treatments? The short answer is yes. Fluids and nutrition (IVs and feeding tubes) are considered forms of lifesustaining treatments for the purpose of end-of-life decision making. What this means is that you (or your Health Care Agent) are allowed to request fluids and hydration be continued or stopped. Like any treatment decision, it is important not only to state what you want or don t want, but why and under what conditions. Also, like any treatment decision, you can change your mind, so long as you clearly make your wishes known. 5. What role does my family play in making medical decisions? Family can play many important roles in health care decision making. You can involve any family member or friend in your health care decisions, but it is best to let your doctor and other health care workers know who is allowed to be told of your condition as well as what roles everyone is to perform. You can determine who (a family member or friend) should be a decision maker for you by assigning that person to be your Health Care Agent.

6 Advance Medical Directives, continued (Page 6 of 7) 6. What if I don t have an Advance Directive? If you do not have an Advance Directive, Arkansas law allows you to designate a Surrogate decision maker (someone who will make medical choices for you) by personally informing your physician verbally or in writing. A Surrogate may make healthcare decisions for you if you are unable to make and communicate decisions for yourself and you have not already appointed a Health Care Agent or your Health Care Agent is not available. A Surrogate will make healthcare decisions based on your wishes or based on the Surrogate s determination of what is in your best interest. To help make sure your wishes are followed, it is best if you designate your own Health Care Agent or Surrogate. If you have not done so and you lose the ability to make and communicate decisions for yourself, Arkansas law allows your doctor to name a Surrogate decision maker on your behalf. The doctor will try to choose the best qualified person to serve as a Surrogate, considering: (1) The ability of the person to make decisions according to your wishes; (2) The frequency of contact with you before and during your illness; (3) The care and concern the person has exhibited for you; and (4) The person s availability and willingness to serve as your Surrogate. The Surrogate does not have to be a relative, but consideration may be given in the following order: (1) Spouse (unless legally separated) (2) Adult child (3) Parent (4) Adult Sibling (5) Any other adult relative (6) Other adult caregiver or friend If your doctor chooses a Surrogate for you, the Surrogate can make most health care decisions for you, except decisions to withhold or stop artificial nutrition or hydration unless your physician and a second, independent physician certify that these treatments are only prolonging the act of dying and you are highly unlikely to regain the ability to make and communicate decisions for yourself. If there is no one eligible to serve as your Surrogate, your physician may make health care decisions for you in consultation with a hospital ethics committee or another independent physician who is not involved in your care. So, to make sure your wishes are followed, it is best for you to document them in an Advance Directive.

7 Advance Medical Directives, continued (Page 7 of 7) 7. In an emergency, how will my Advance Directive be used? Remember: Living Wills are legally recognized only when you are permanently unconscious or dying and are unable to speak for yourself. In most cases, physicians need some time to determine whether or not you meet one of these two conditions. So, many treatments may be started in order to evaluate your condition, but these treatments can be stopped if it is determined that you meet one of the two conditions (permanently unconscious or terminally ill) and stopping treatment is what you would want according to your Living Will. This document is intended to provide you with information on how to complete Advance Directives. You can use the forms at the end of this document to create Advance Directives or to designate a Surrogate. This document is not intended to provide you with legal advice and is not a substitute for the advice of an attorney. Revised 11/15

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