Advance Directives

Advance Directives

Advance directives consist of a healthcare power of attorney, a living will, and do-not-resuscitate orders. The patient advocates and the social work staff are available to assist patients, their family members and the community at large with information on and completion of advance directives. These services are provided at no charge.

Advance Directives: Tools to Help You and Your Family

You have a right to have your wishes regarding your care and treatment honored, even when you cannot speak for yourself. Advance directives are documents that can help you and your family in the event that you become that ill.

What are advance directives?

Advance directives are legal written documents that indicate what the individual wants regarding care and treatment if he or she is not able to speak for himself or herself. There are three documents: a healthcare power of attorney, a living will and a do-not-resuscitate order. All must be signed by the competent patient and witnessed or notarized.

When are advance directives needed?

Advance directives are needed when a patient is considered by his or her doctor to be unable to make decisions regarding treatment or care.

What is a healthcare power of attorney?

A healthcare power of attorney is a legal document that names the individual the patient chooses to be his or her proxy if the patient cannot speak for himself or herself. The proxy can only act as the patient's spokesperson during the time the patient is considered incapable of doing so. As soon as the patient is able to make decisions again, the proxy has no authority over the patient. The proxy's obligation during the patient's incapacity is to make healthcare decisions on behalf of the patient and in accordance with the patient's wishes or values.

Can I name more than one person in my healthcare power of attorney?

Only one proxy is named in a healthcare power of attorney. Up to two alternates can also be named to provide a backup if the primary proxy cannot be reached. These individuals are only alternates.

Can my proxy pay my bills?

The proxy named in the healthcare power of attorney has no authority over financial matters and is not obliged to pay for the individual's healthcare. A separate power of attorney for finances may be completed with the advice and assistance of an attorney to handle financial arrangements. The proxy listed in the the power of attorney for finances does not generally have authority in healthcare decisions.

What is a living will?

A living will states that if a patient becomes unable to speak for himself or herself and reaches a terminal condition or is in a permanent vegetative state, he or she does not want further life-prolonging treatments. At that point, the individual wants only treatments that keep him or her comfortable during the dying process.

If I don't have advance directives, what happens if I can't speak for myself?

Under Ohio law, if a person does not have a healthcare power of attorney and is unable to speak for himself or herself, the person's next of kin makes all healthcare decisionsl This is the order of precedence:

  • Spouse (Ohio law does not recognize common-law marriages as a legally valid marriage.)
  • Adult children—decisions are made by the majority of the adult children available for consultation in person or by phone. (No one child has priority over any other, regardless of birth order.)
  • Parent(s)
  • Sibling(s)—decisions are made by the majority of the siblings available for consultation in person or by phone.
  • Closest relative available for consultation in person or by phone

Who can complete an advance directive?

Any competent individual over 18 years of age may complete an advance directive. That individual is the only individual who can revoke or revise the document if desired.

Do the documents need to be notarized?

In order to be legally valid, the individual completing the document needs to have his or her signature notarized or witnessed by two witnesses unrelated to the individual by blood or marriage and not named in the document.

When would these documents be considered valid?

The advance directives are considered valid from the time the individual's signature is witnessed until he or she revokes or revises them. They are considered valid throughout the state of Ohio and at any Ohio medical facility. If the individual is in another state and encounters a medical emergency, that state's laws determine the validity. Most states will honor such documents in an emergency situation.

Does a living will mean the patient is not going to be resuscitated in the event of a cardiac or respiratory arrest?

No. A living will does not automatically mean "No code" or "Do not resuscitate." A do-not-resuscitate (DNR) order is a separate decision to be made between the patient (or proxy) and the physician. A living will may include a statement indicating that the patient wants a DNR order written at the time the living will is implemented. However, it still requires the physician to write the separate DNR order.

What is a do-not-resuscitate (DNR) order?

A do-not-resuscitate order is an order specifically written by the doctor after discussion with the patient (or proxy) indicating that in the event of a cardiac or respiratory arrest, the patient does not want CPR attempted. It does not mean do not treat. The patient may still receive diagnostic testing, artificial food, water and treatments not associated with resuscitative efforts if needed or desired.

What is the difference between a do-not-resuscitate comfort care (DNRCC) order and a do-not-resuscitate comfort care arrest (DNRCC-arrest) order?

A do-not-resuscitate comfort care order indicates that as of the time the patient and physician sign the DNRCC order, the patient will not have any further cardiac or respiratory efforts started whose sole purpose is resuscitation. This includes the use of cardiac monitoring, intubation (tube placed down the patient's throat to provide an airway), defibrillation, resuscitative medications or chest compressions (CPR). Comfort measures will always be maintained.

A do-not-resuscitate comfort care arrest order indicates that the order which the patient and physician have signed (DNRCC-Arrest) will be used only when the patient actually suffers a cardiac or respiratory arrest. At that point, no cardiac or respiratory efforts will be started whose purpose is solely resuscitation. Comfort measures will be maintained. Prior to that point, all treatments, including cardiac monitoring and even intubation, will be used if needed and desired.

If you have any questions regarding do-not-resuscitate orders, please contact your family physician.