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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:
1. Durable Power of Attorney for Health Care
2. Living Will
3. 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 medical record.

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 Order A 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.

Your decisionsThese 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.