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
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
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
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.