Hospice of Kitsap County
Advance Directives: The Patient’s Right to Decide

All adult individuals in hospitals, nursing homes, and other health care settings have certain rights.  For example, you have the right to confidentiality of your medical records and to know what treatment you will receive.  You also have another right.  You have the right to fill out a paper, known as an “advanced directive”.  The paper says in advance what kind of treatment you want or do not want under special, serious medical conditions—conditions that would prevent you from telling your doctor how you want to be treated.  For example, if you were taken to the hospital in a coma, would you want the hospital’s medical staff to know your specific wishes about decisions affecting your treatment?

WHAT IS AN ADVANCE DIRECTIVE?

Advance Directives are documents that clearly state what kind of health care you want and do not want, if you can't speak for yourself. They are called "advance" because decisions are made by you, while you are able to do so, and before the document is needed.

Preparing an advance directive does many good things:

• It provides you peace of mind, knowing that if you are not able to communicate what care you want in a health care emergency, your wishes will still be carried out.
• It provides your loved ones with clear directions for your care. This is a great gift to your family, and means they won't have to try to guess what care you would and would not want, at a time when they will be under great emotional stress. It can also prevent family arguments about what is best for you.
• It enables your health care providers to make clear decisions that they know reflect your final wishes.

Advance Directive Components: Living Will & Durable Power of Attorney

There are two kinds of advance directives for health care, and in general, you should have both.

You can use standardized forms (see the Durable Power of Attorney form sample) or create documents with the assistance of an attorney. To assure validity, these documents should be signed by you, dated and witnessed. Each form will have instructions for correctly completing it.

The living will is a message from you to your health care providers in regard to the kind of care you do and do not want if you can no longer make your own decisions. The topics usually covered in a living will include directives about artificial feeding, use of a respirator if you cannot breathe on your own, and whether or not you wish to have cardiopulmonary resuscitation (CPR) if your heart stops. You don't have to respond to every question in a standardized living will format; if you don't answer, then your health care provider will make those decisions. Also you can add more information detailing what you do and do not want on these forms. Many living will standard forms are vague, and so it is up to you to add the details that make it appropriate for your care, as you want it.

A living will form does not name a person who will be responsible for your care decisions if you are not able to make them; for this, you also need a durable power of attorney, discussed below.

Bear in mind that having a living will that limits care in some areas does NOT mean that you will no longer receive care. You are entitled to medical care to make you comfortable as long as you are alive, and your legal documents do not change that.

The durable power of attorney for health care, or DPOA designates another person to act as your representative/ health care agent in making medical decisions for you if you cannot make them. It is simpler than a living will, in that it usually just states that if you are unable to make your own health care decisions, you want the person you name in the document to do so for you. This document does not have a list of the kinds of care you do and do not want.

*An excellent living will "template" is the FIVE WISHES.   Please ask a member of your Hospice team for a free copy of the FIVE WISHES if you  do not have a living will, or if you would like more information.

The person you choose to have as your health care power of attorney should be someone you trust and who agrees with your views about end-of-life medical care. This should also be a person who has agreed to accept this important responsibility.

A special note: Having a will and/or power of attorney governing other aspects of your life does not cover health care decisions. Health care decision-making must be covered separately, in the kinds of documents described above.

DO I HAVE TO WRITE OR SIGN AN ADVANCE DRIECTIVE UNDER THE LAW?  No.  It is entirely up to you.

WHAT IF I FILL OUT AN ADVANCE DIRECTIVE IN ONE STATE AND AM IN NEED OF CARE IN A DIFFERENT STATE?

The law on honoring an advance directive from another state is unclear.  Because an advance directive tells your wishes regarding medical care, however, it may be honored wherever you are, if it is made known.

WHAT SHOULD I DO WITH MY ADVANCE DIRECTIVE IF I CHOOSE TO HAVE ONE?

Make sure someone, such as your lawyer or a family member, knows that you have an advance directive and knows where it is located.  You may wish to consider the following:

• If you have a durable power of attorney document, give a copy or the original to your “agent” or “proxy”.
• Ask your physician(s) to make your advance directive part of your permanent medical record.
• Keep a copy of your advance directive in a place where it can easily be found.
• Keep a card in your wallet or purse, which states that you have an advance directive and where it is located and who your “proxy” or “agent” is, if you have named one.

CAN I CHANGE MY MIND AFTER I WRITE A LIVING WILL OR HEALTH CARE POWER OF ATTORNEY?

Yes.  You may change or cancel these documents at any time in accordance with state law.  Any change or cancellation should be written, signed, and dated in accordance with state law, and copies should be given to your doctor and others to whom you may have given copies of the original.

WE ADVISE YOU TO CONSULT WITH YOUR ATTORNEY CONCERNING SPECIFIC QUESTIONS CONCERNING ADVANCE DIRECTIVES.

If you need additional general information or would like a resource list, please ask the Hospice staff (360) 698-4611.