MAKING TREATMENT AND END-OF-LIFE DECISIONS
Rights and decisions of patients and familiesGarden City Hospital is committed
to assuring and protecting the patient’s right to self-determination
and autonomy regarding consent to treatment. This commitment includes
the physical, emotional, psychological and spiritual care of each patient.
You the patient and your family may have to make many decisions while
you are in the hospital. Some of these decisions are more difficult than
others and at times additional information is needed to make these decisions.
Doctors, nurses and social workers can provide the information needed.
Discussions with your support person may be helpful in making these decisions.
Some of the more common decisions that may need to be made are: consent
for surgery and/or treatment; organ/tissue donations; whether to use life
support or whether to stop some type of treatment in progress. You may
require time to think, ask questions and discuss options with your support
person. It is helpful to give thought to these decisions before they occur,
as it is usually difficult to make them under pressure.
Who makes the decisions?Your doctor is responsible for diagnosing and
managing the illness or condition and prescribing medications and treatments.
There are times when you have to choose between different kinds of treatment.
To make the best decision possible you may want to discuss the following
points with the doctor:
- How will this treatment affect my condition?
- What are the benefits of treatment?
- What are the risks of treatment?
- How long will the treatment need to continue?
This is the time to be honest and open with your physician so that the
decision that is made will reflect your values and true feelings. As the
illness changes or progresses (for better or worse), more decisions may
need to be made. Discussing your feelings with your family is also important
so they know how you feel to support your choices.
What if I am unable to make decisions?Your family and doctor may need
to make decisions if you are unable to do so. Those decisions should express
what you would want done in that situation. Even though it is difficult
to discuss illness, treatment and the possibility of death, sharing views
with your family and physician will help them carry out your wishes.
Advance DirectivesWhile it may be difficult to talk to family members
or friends about serious illness or end of life decision making it is
far easier for them, if we determine how we would like our health care
needs attended to in the event that we are unable to participate in medical
treatment decisions. There are several ways that you can make your future
health care wishes known and that is by executing certain documents which
are known as “Advance Directives.”
There are three types of Advance Directives that you should consider and they are:
- Durable Power of Attorney for Health Care
- Living Will
- Do-Not-Resuscitate (DNR) Order
You may select one of these options, all of these options or none of these
options. The decision is strictly yours. In order to assist you with this
decision a brief description of each of these documents is discussed below.
Durabable Power of Attorney for Health CareA durable power of attorney
for health care, is a document in which you appoint another person to
make medical treatment and related personal care decisions for you. The
person you appoint to make your health care decisions is known as the
“Patient Advocate.” In order to execute one of these documents,
you need to be at least 18 years of age and you must be mentally competent
at the time you sign the document.
The health care power of attorney must be in writing, signed by the patient,
dated, and witnessed by two people who are disinterested, competent adults.
In other words, physicians, hospital employees, your spouse, parents,
children, grandchildren, and brothers and sisters cannot witness your
signature. Additionally, anyone who would be a beneficiary of your estate
should not serve as a witness to this document. The person you select
as your “Patient Advocate” must accept in writing that they
are willing to perform in this role. Therefore, it is important for you
to discuss this matter with the person you would like to act as your “Patient
Advocate.” It is important to note that your Patient Advocate may
only act on your behalf when you are unable to participate in the decision
making process. The doctor responsible for your care and one other doctor
or psychologist will make that determination of when you are no longer
capable of making decisions about your health care.
There are areas in the health care power of attorney which discuss specific
treatment choices that you may choose to make. For instance, you may authorize
your patient advocate to decide to withhold or withdraw treatment that
would allow you to die, such as ventilators, feeding tubes, etc. In this
document you may also choose to give your patient advocate the power to
arrange for medical and personal care services, and to pay for those services
using your funds. Your patient advocate will not have the power to handle
all of your property and finances.
Once you have completed this document you should keep it in a safe, accessible
place so it is easily found if needed. You should give a copy of the document
to your Patient Advocate so they have one readily available to them. You
may also wish to provide your doctor’s office and each of your family
members with a copy. If you have already completed one of these documents
you may give it to the admitting department or if you have not and would
like to complete one, you may request the Health Care Power of Attorney
form from the Registration Department. You may contact them at 734-458-4461.
The Registration Department will place a copy of this document in your
Living WillA living will is a written document in which you inform, doctors,
family members and others what type of medical care you wish to receive
should you become terminally ill or permanently unconscious. Aliving will
only becomes effective after a doctor diagnoses you as terminally ill
or permanently unconscious and determines you are unable to make or communicate
decisions about your care.
Although there is some overlap between a Durable Power of Attorney for
Health care and a Living Will, the focus of the health care power of attorney
is on who makes the decision and the focus in the living will is on what
the decision should be. A living will is limited to care during terminal
illness of permanent unconsciousness, while a patient advocate acting
under a health care power of attorney may also have authority in circumstances
of temporary disability. A living will can be honored without the presence
of a third person making the actual decision.
In either a living will or a durable power of attorney for health care
you may express wishes such as the following:
“Do whatever is necessary for my comfort, but nothing further.”
“I authorize all measures to be taken to prolong my life.”
“I do not want any extraordinary measures taken to prolong my life.”
Or, you may state whether or not you wish specific medical interventions,
such as a respirator, cardiopulmonary resuscitation (CPR), surgery, antibiotic
medication, and blood transfusions. You could even authorize experimental
or nontraditional treatment.
Michigan has never passed a statute relating to living wills. However,
there have been legal decisions rendered in Michigan courts that have
recognized a living will. Since there is no state law pertaining to living
wills, there are no formal requirements relating to how they are executed.
It is therefore strongly recommended that the document be entitled “living
will; dated; signed by you; and signed by two witnesses who are not family
members. You may have both a durable power of attorney for healthcare
and a living will. Your Patient Advocate can read your living will as
an expression of your wishes. The living will might also be valuable if
your patient advocate were unavailable when a decision needed to be made.
If you have both documents, make sure that your wishes expressed in both
documents are consistent.
Do-Not-Resuscitate OrderA do-not-resuscitate order (DNR order) is a written
document in which you express your wish that if your breathing and heartbeat
cease, you do not want anyone to attempt to revive you. Aperson who is
terminally ill may wish to fill out a do-not resuscitate form. Michigan
law recognizes a DNR. This form must be signed by you, your physician,
and witnessed by two non-family members. If you wish to fill out this
document it is available to you in the Registration Department.
Organ and tissue donation decisions Michigan law currently requires that
hospitals ask all patients their wishes regarding donating tissues or
body organs if there is a death. Tissue donation can include: eyes, skin,
bone and other tissue. Organ donations include: kidneys, heart, liver
and pancreas. The nursing staff is available to answer questions and to
assist you in making these decisions or donation arrangements.
These decisions are not intended to make you uncomfortable, rather they
are intended to ensure that you are a part of your medical treatment choices.
Spending some time thinking about these concerns and discussing them with
your doctor, family or support person can help you make better decisions.