Questions about medical care at the end of life are very important because of the ability of medical technology to prolong life and because of highly publicized court cases involving comatose or dying patients. The best way for you to be in control of your medical treatment in such a situation is to record your preferences in an Advanced Directive.
At SGMC, we use the State of Georgia’s Critical Conditions Planning Guide. By completing the steps outlined in this booklet, you can prepare yourself and loved ones to make these difficult decisions.
Advanced Directives – Frequently Asked Questions
WHAT ARE ADVANCE DIRECTIVES?
Advance directives are documents written in advance of serious illnesses which state your choices about medical treatments, or name someone to make choices about medical treatments for you, if you become unable to make the decision. Through advance directives such as the Living Will, Durable Power of Attorney for Health Care, and Directive for Final Health Care, you can make legally valid decisions about future medical treatments.
WHAT IS A LIVING WILL?
A Living Will is a document in which you can instruct your physician to withhold or withdraw life-sustaining procedures if you become terminally ill, are in a coma, or are in a persistent vegetative state with no reasonable likelihood of recovering. A Living Will must specifically state your desire to forego life-sustaining care under these circumstances. State law describes the kind of form, which must be used in order to have a valid living will. A Living Will must be signed, dated, and witnessed. A lawyer is not needed to draw up a Living Will, although you may decide legal consultation is desirable.
WHAT IS A DURABLE POWER OF ATTORNEY FOR HEALTH CARE?
A Durable Power of Attorney for Health Care is another kind of advance directive: a signed, dated, and witnessed legal document in which you can name another person, an agent, to make medical decisions for you, if you become unable to make them. In a healthcare power of attorney, you can describe treatment you want and do not want. Also, this form of advance directive can relate to any medical condition, such as Alzheimer’s Disease, not just a terminal illness. Georgia law describes a healthcare power of attorney form, but other forms are also acceptable. A Durable Power of Attorney for Health Care can be written without the advice of a lawyer, although you may decide consultation with your attorney would be helpful.
WHAT IF I HAVE A LIVING WILL AND A DURABLE POWER OF ATTORNEY FOR HEALTH CARE?
If you have both a Living Will and a Durable Power of Attorney for Health Care, the Living Will is ineffective and inoperative if you have an agent available to exercise the durable power of attorney unless the Durable Power of Attorney for Health Care specifically provides otherwise.
WHAT IS A DIRECTIVE FOR FINAL HEALTH CARE?
A Directive for Final Health Care is a legal format for expressing your final healthcare wishes. You do not have to use a lawyer to complete the form. This directive combines the concept of both the Living Will and the Durable Power of Attorney for Health Care into one very comprehensive, legal document. With this directive, you may legally appoint a personal agent to make healthcare decisions when you cannot speak for yourself and formally state your wishes for the medical treatments you do or do not want to receive.
ARE ADVANCE DIRECTIVES JUST FOR “SENIOR CITIZENS?”
No. A severe illness or serious accident can happen to a person at any age. If you have strong feelings about what choices you would want made in such a situation, regardless of your age, you are encouraged to consider completing an advance directive.
WHAT DOES THE GEORGIA LAW SAY ABOUT THIS SUBJECT?
Generally, you have the right to refuse any medical or surgical treatment you do not wish to receive. Georgia state law allows you to sign advance directives so that your wishes will be followed, even if you become unable to communicate them to your healthcare provider.
WILL AN ADVANCE DIRECTIVE BE HONORED IN AN EMERGENCY?
Usually, it is impossible to determine the chances of survival in an emergency situation or to determine the outlook for recovery. After the initial emergency has passed and depending on your condition, your advance directive may come into play if you are not able to express your wishes.
IS IT DIFFICULT TO STOP TREATMENT ONCE IT HAS BEEN STARTED?
No, not if you have an advance directive and your instructions are clear. If your condition begins suddenly, it may take days or even weeks before the outlook for recovery is known. During this time it is appropriate to use any treatment, which might be beneficial. When the outlook for your recovery is known, and if your instructions indicate you would not want continued treatment under these circumstances, treatment can be stopped.
IS THERE A TIME LIMIT ON HOW LONG MY ADVANCE DIRECTIVE IS VALID?
You are encouraged to update any advance directive periodically since this indicates that you have given the matter a great deal of thought. An advance directive dated prior to 1987 may state it is only good for seven years.
ARE THERE ANY LIMITATIONS ON CARRYING OUT THE INSTRUCTIONS IN MY DIRECTIVE IF I AM PREGNANT?
Yes, most likely any instructions which would result in withholding or withdrawing life-prolonging treatments would not be honored during the time you are pregnant. If you are pregnant, the living will has no force and effect unless the fetus is not viable and you indicate by initialing the appropriate statement on your copy of the living will that you want the living will carried out.
AFTER I COMPLETE AN ADVANCE DIRECTIVE, WHAT DO I DO WITH IT?
Copies of an advance directive should be given to someone who would know if you became seriously ill. You should also give a copy to your physician and you may want to consider giving a copy to your minister, family members or close friends. Of course, if you appoint an agent to make health care decisions for you, you should give a copy of your advance directive to the agent. Finally, you should consider carrying a card in your wallet stating that you have signed an advance directive and where it is located.
WILL MY GEORGIA ADVANCED DIRECTIVE BE HONORED IF I AM ADMITTED FOR TREATMENT IN A DIFFERENT STATE?
The laws honoring advance directives differ from state to state, so it is unclear whether a Georgia advance directive would be valid in a different state. Because an advance directive is an expression of your wishes about medical care, it will influence that care no matter where you are admitted. However, if you spend a great deal of time in more than one state, you might consider signing an advance directive that meets all the requirements of each state.
CAN I BE REFUSED ADMISSION TO A HOSPITAL IF I DO NOT HAVE AN ADVANCE DIRECTIVE?
Federal law prohibits a hospital from refusing to admit a patient because he or she does not have an advance directive. However, as of December 1, 1991, hospitals must ask adult inpatients if they have advance directives, document their answers, and provide information on state laws and hospital policies about advance directives.
DOES THIS HOSPITAL HAVE A POLICY ABOUT ADVANCE DIRECTIVES?
Yes, it is the policy of this hospital to honor a patient’s advance directive, if it meets the requirements of state law. We also recognize and respect the right of patients to accept or reject offered medical or surgical treatment, to the extent permitted by law.
MAY A PROVIDER REFUSE TO IMPLEMENT MY DIRECTIVES?
Yes. A provider who is unwilling to comply with an advance directive (i.e., conscientious objection) will arrange for transfer of your care to another provider.