End-of-life and Treatment Decisions

Garden 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. The patient and their family may have to make many decisions while in the hospital. Some of these decisions are more difficult than others and at times additional information is needed.

Doctors, nurses and social workers can provide the information needed, and discussion with your support person may be helpful in making these decisions. Some common decisions that may need to be made are: consent for surgery and/or treatment, organ/tissue donation, and whether to use life support or to stop some type of treatment in progress. It is helpful to give thought to these decisions before they occur, as it is difficult to make them under pressure. You may require time to think, ask questions and discuss options with your support person.

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 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 doctor so that the decision that is made will reflect your values and true feelings. As the illness changes or progresses, more decisions may need to be made. Discussing your feelings with your family is also important so they know how you feel in order 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 doctor will help them carry out your wishes.

Advance Directives - While 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:

• Durable Power of Attorney for Health Care
• Living Will
• Do-Not-Resuscitate Order (DNR)

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.

Durable Power of Attorney for Health Care - A 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 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 and dated by the patient, and witnessed by two people who are disinterested, competent adults. In other words, doctors, 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. 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 at 734-458-4461. The Registration Department will place a copy of this document in your medical record.

Living Will - A 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. A living 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 or 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 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.”

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 non-traditional 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" which is dated and signed by you, and signed by two witnesses who are not family members. You may have both a durable power of attorney for health care 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 is unavailable when a decision needs to be made. If you have both documents, make sure your wishes expressed are consistent.

Do-Not-Resuscitate Order (DNR) - A do-not-resuscitate 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. A person who is terminally ill may wish to fill out a DNR form. Michigan law recognizes a DNR. This form must be signed by you, your doctor, 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 - Michigan law currently requires that hospitals ask all patients their wishes regarding donating tissues or body organs in the event of a death. Tissue donation can include: eyes, skin, bone and other tissues. Organ donation can include: kidneys, heart, liver and pancreas. The nursing staff is available to answer questions and 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.