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Advanced Directives

Important Things to Consider

You can make decisions and issue directives now that will ensure that your wishes are followed in the event you become incapable of making important decisions about the medical care you receive. It is the policy of ViaHealth's affiliates to follow the wishes you have expressed in a properly executed Health Care Proxy and/or Living Will

This section contains information and forms for two kinds of Advance Directives:

Health Care Proxy:
Designating another person to make medically related decisions for you.

Advance Care Directive (Living Will):
Designating your future health care treatment choices.

This material was provided by the New York State Department of Health. Please read the instructional material and forms carefully, make as many copies as you need and discuss them with your family, doctor and close friends.

Your Right to Decide About Treatment

Adults in New York State have the right to accept or refuse medical treatment, including life-sustaining treatment. Our Constitution and state laws protect this right. This means that you have the right to request or consent to treatment, to refuse treatment before it has started, and to have treatment stopped once it has begun.

Planning in Advance

Sometimes because of illness or injury people are unable to talk to a doctor and decide about treatment for themselves. You may wish to plan in advance to make sure that your wishes about treatment will be followed if you become unable to decide for yourself for a short or long period. If you don't plan ahead, family members or other people close to you may not be allowed to make decisions for you and follow your wishes.

In New York State, appointing someone you can trust to decide about treatment if you become unable to decide for yourself is the best way to protect your treatment wishes and concerns. You have the right to appoint someone by filling out a form called a Health Care Proxy. A copy of the form and information about the Health Care Proxy are available from your health care provider as well as this website.

If you have no one you can appoint to decide for you, or do not want to appoint someone, you can also give specific instructions about treatment in advance. Those instructions can be written, and are often referred to as a Living Will.

You should understand that general instructions about refusing treatment, even if written down, may not be effective. Your instructions must clearly cover the treatment decisions that must be made. For example, if you just write down that you do not want "heroic measures," the instruction may not be specific enough. You should say the kind of treatment that you do not want, such as a respirator or chemotherapy, and describe the medical condition when you would refuse treatment, such as when you are terminally ill or permanently unconscious with no hope of recovering. You can also give instructions orally by discussing your treatment wishes with your doctor, family members or others close to you.

Putting things in writing is safer than simply speaking to people, but neither method is as effective as appointing someone to decide for you. It is often hard for people to know in advance what will happen to them or what their medical needs will be in the future. If you choose someone to make decisions for you, that person can talk to your doctor and make decisions that they believe you would have wanted or that are best for you, when needed. If you appoint someone and also leave instructions about treatment in a Living Will, in the space provided on the Health Care Proxy form itself, or in some other manner, the person you select can use these instructions as guidance to make the right decision for you.

Deciding About Cardiopulmonary Resuscitation

Your right to decide about treatment also includes the right to decide about cardiopulmonary resuscitation (CPR). CPR is emergency treatment to restart the heart and lungs when your breathing or circulation stops.

Sometimes doctors and patients decide in advance that CPR should not be provided, and the doctor gives the medical staff an order not to resuscitate (DNR order). If your physical or mental condition prevents you from deciding about CPR, someone you appoint, your family members, or others close to you can decide. A brochure on CPR and your rights under New York law is available from your health care provider.

What is a Health Care Proxy?

A law, called the New York health care proxy law, allows you to appoint someone you trust - for example, a family member or close friend - to decide about treatment if you lose the ability to decide for yourself. You can appoint someone by signing a form called a Health Care Proxy.

You can give the person you select, your "health care agent," as little or as much authority as you want. You can allow your health care agent to decide about all health care or only about certain treatments. You may also give your agent instructions that he or she has to follow. Your agent can then make sure that health care professionals follow your wishes and can decide how your wishes apply as your medical condition changes. Hospitals, doctors and other health care providers must follow your agent's decisions as if they were your own.

Why should I choose a health care agent?

If you become too sick to make health care decisions, someone else must decide for you. Health care professionals often look to family members for guidance. But family members are not allowed to decide to stop treatment, even when they believe that is what you would choose or what is best for you under the circumstances.

Appointing an agent lets you control your medical treatment by:

  1. allowing your agent to stop treatment when he or she decides that is what you would want or what is best for you under the circumstances
     
  2. choosing one family member to decide about treatment because you think that person would make the best decisions or because you want to avoid conflict or confusion about who should decide
     
  3. choosing someone outside your family to decide about treatment because no one in your family is available or because you prefer that someone other than a family member decide about your health care.

How can I appoint a health care agent?

All competent adults can appoint a health care agent by signing a form called a Health Care Proxy. You don't need a lawyer, just two adult witnesses. You can use the form printed here, but you don't have to.

When would my health care agent begin to make treatment decisions for me? 

Your health care agent would begin to make treatment decisions after doctors decide that you are not able to make treatment decisions. As long as you are able to make treatment decisions for yourself, you will have the right to do so.

What decisions can my health care agent make?

Unless you limit your health care agent's authority, your agent will be able to make any treatment decision that you could have made if you were able to decide for yourself. Your agent can agree that you should receive treatments, choose among different treatments, and decide that treatments should not be provided, in accord with your wishes and interests. If your health care agent is not aware of your wishes about artificial nutrition and hydration (nourishment and water provided by feeding tubes), he or she will not be able to make decisions about these measures. Artificial nutrition and hydration are used in many circumstances, and are often used to continue the life of patients who are in a permanent coma.

How can give my agent written instructions?

See "How to Fill Out a Health Care Proxy."

How will my health care agent make decisions?

You can write instructions on the proxy form. Your agent must follow your oral and written instructions, as well as your moral and religious beliefs. If your agent does not know your wishes or beliefs, your agent is legally required to act in your best interests.

Who will pay attention to my agent?

All hospitals, doctors and other health care facilities are legally required to obey the decisions by your agent. If a hospital objects to some treatment options (such as removing certain treatment) they must tell you or your agent IN ADVANCE.

What if my health care agent is not available when decisions must be made? 

You can appoint an alternate agent to decide for you if your health care agent is not available or able to act when decisions must be made. Otherwise, health care providers will make treatment decisions for you that follow instructions you gave while you were still able to do so. Any instructions that you write on your Health Care Proxy form will guide health care providers under these circumstances.

What if I change my mind?

It is easy to cancel the proxy, to change the person you have chosen as your health care agent, or to change any treatment instructions you have written on your Health Care Proxy form. Just fill out a new form. In addition, you can require that the Health Care Proxy expire on a specified date or if certain events occur. Otherwise, the Health Care Proxy will be valid indefinitely. If you choose your spouse as your health care agent and you get divorced or legally separated, the proxy is automatically cancelled.

Can my health care agent be legally liable for decisions made on my behalf? 

No. Your health care agent will not be liable for treatment decisions made in good faith on your behalf. Also, he or she cannot be held liable for costs of your care, just because he or she is your agent.

Is a Health Care Proxy the same as a Living Will?

No. A Living Will is a document that provides specific instructions about health care treatment. It is generally used to declare wishes to refuse life-sustaining treatment under certain circumstances.

In contrast, the Health Care Proxy allows you to choose someone you trust to make treatment decisions on your behalf. Unlike a Living Will, a Health Care Proxy does not require that you know in advance all the decisions that may arise. Instead, your health care agent can interpret your wishes as medical circumstances change and can make decisions you could not have known would have to be made. The Health Care Proxy is just as useful for decisions to receive treatment as it is for decisions to stop treatment. If you complete a Health Care Proxy form, but also have a Living Will, the living will provides instructions for your health care agent, and will guide his or her decisions.

Where should I keep the proxy form after it is signed?

Give a copy to your agent, your doctor and any other family members or close friends you want. You can also keep a copy in your wallet or purse or with other important papers.

What about the “Medical Orders for Life-Sustaining Treatment” (MOLST) document?

Individuals/patients have a right to make their own health care decisions. The “Medical Orders For Life-Sustaining Treatmen ” (MOLST) is a document designed to help health care providers honor the treatment wishes of their patients. It is a physician order form. The MOLST is not intended to replace an advance directive document (i.e. health care proxy form or living will).

The MOLST form was created by a multi-disciplinary community-wide panel of health care providers and consumers in the Rochester, NY area and is intended to give patients the opportunity to express their preferences with regard to cardiopulmonary resuscitation, mechanical intervention, and other life-sustaining treatment. The document was modeled after a similar form that has been in use for ten years in the state of Oregon, the POLST (Physician Orders for Life-Sustaining Treatment), and has been adapted for use in New York State where there are special legal and policy considerations guiding these decisions.

 

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Appointing a Health Care Agent is a serious decision. Make sure you talk about it with your family, close friends and your doctor. Do it in advance, not just when you are planning to enter the hospital.

What you should know about filling out the Health Care Proxy Form & Advance Care Directive (Living Will) Form

How to fill out the Health Care Proxy & Advance Care Directive (Living Will) Forms

Health Care Proxy Form

Advance Care Directive (Living Will) Form

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Organ and Tissue Donation

There is one more thing to consider while doing advanced planning for health care - organ and tissue donation. By completing an anatomical gifts card and notifying your family and agent, you can make a gift of improved quality of life or even life itself to another person in the event of your death.

Thousands of people wait each year for transplants which, today, are very successful. But the need is much greater than the organs available. Patients wait for these organs...hearts, livers and kidneys. They wait for tissues...bone, corneas and heart valves. Donated organs and tissues from one person can help many people...to see clearly again, to walk on a strong leg, to stay off a kidney dialysis machine, to live!

The medical condition of the organs and tissues at the time of death determine what can be donated. Since we don’t know the future, all of us should consider ourselves possible donors. We can pledge now to be a future donor.

There are never costs to the organ or tissue donor’s family for the donation.

Major religious groups encourage organ donation. Discuss this, if you wish, with your clergy.

Donation is a surgical procedure respectful of the body. There is no need to change your desired funeral arrangements. An open casket service is possible.

By completing an anatomical gifts card and notifying your family and agent, you can make a gift of improved quality of life or even life itself to another person in the event of your death.

For further information contact:

Rochester Eye and Human Parts Bank
524 White Spruce Blvd
Rochester, NY 14623
(585) 272-7890
(800) 568-4321

www.rehpb.org
e-mail: tissue@frontiernet.net