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The importance of Advance Directives

Making informed choices.
We greatly respect the rights of our patients to choose their course of care. This means choosing among available treatments as well as choosing to withhold or stop treatment at any time. These choices are always noted on the patient’s medical record.

Problems sometimes arise when a person is unable to communicate choices because of an accident or illness. Advance directives give patients a way to protect their rights in such cases, allowing them to decide, now, what type of treatment they will or will not want, later. It’s also an opportunity to appoint a surrogate who will make key health decisions if that becomes necessary.

How do I make advance directives?
The Michigan Patient Self-Determination Act, Michigan Law PA 312 of 1990, recognizes the validity of a Durable Power of Attorney for Healthcare. This is a legal document in which you can appoint a relative or close friend who will become your surrogate decision-maker for healthcare matters.

Durable Power of attorney for Healthcare.
Click here to download a form that allows you to appoint someone to be your spokesperson regarding health matters if you are not able to speak for yourself. Print out the form from your computer, fill it out and give a copy to your assigned spokesperson, your doctor and your attorney.

Note: This form requires the software Acrobat Reader. If you need to download Acrobat Reader, free of charge, click the icon.

Durable Power of Attorney for Healthcare and Living Will forms.
Anyone over 18 can witness the signatures of the patient and surrogate, except: a spouse, a child, a grandchild, a brother or sister, an employee of a company that provides you with life or health insurance, or an employee of the healthcare agency or institution that is caring for you. A living will should be witnessed the same way.

You can also request a copy by calling our administrative office at 888-247-5701. Your surrogate must accept the role in writing, by signing the Durable Power of Attorney for Healthcare form. Notarization is not necessary, but the form must be witnessed.

What does a surrogate do?
Surrogates make decisions on your behalf if you are unable to do so, including decisions on whether to begin, withhold or withdraw life-sustaining treatments. Life-sustaining treatments include resuscitation, use of ventilators, dialysis, surgery and the giving of fluids, and nutrition by artificial means, such as IV lines and tubes.

The surrogate’s job is to make the same choices you would make if you were able. Therefore, the surrogate, also called a patient advocate, should be someone you trust who knows how you feel about healthcare issues. Patients can help the surrogate by learning as much as they can about the choices that may have to be made and by sharing their values and preferences.

Why are advance directives important?
Advance directives protect a person’s right to make choices that affect his or her life. They are a way of letting loved ones and physicians know a person’s deepest wishes. Without advance directives, others often have to make decisions, which may or may not be in line with the patient’s wishes. This places a heavy burden on them.

What is a living will?
A living will is another form of advance directives. At this time, it is not legally binding in Michigan, but it is still valuable in letting loved ones and health care providers know one’s wishes. A living will allows people to state specifically what type of treatment they do or do not want. For example, a person can authorize transfusions and IV lines but refuse ventilator care. Someone can also specify the circumstances under which they will and will not accept certain treatments.

How do health care providers decide who is unable to make decisions for themselves?
People may become temporarily or permanently unable to make informed decisions about medical care because of unconsciousness, coma, persistent vegetative state, brain injury, mental illness or the influence of mind-altering drugs. The attending physician, often in consultation with other physicians and medical professionals, determines whether or not a patient is competent to make an informed decision about medical care. If the condition is temporary, the physician will determine when the patient is again able to make such decisions.

What do I do with my advance directives after the forms are signed and witnessed?
Give a copy to your physician, to your surrogate, and to family or friends who would likely be notified in an emergency. It’s a good idea to keep a card in your wallet stating that you have advance directives and noting where they can be found.

You should review your advance directives periodically and change them as necessary. When you are admitted as a patient by a hospital or healthcare agency, you will be asked if you have completed advance directives. You should give the admissions officer a copy for your medical record.

You can also request a copy by calling 888-247-5701. Your surrogate must accept the role in writing, by signing the Durable Power of Attorney for Health Care form. Notarization is not necessary, but the form must be witnessed.

Will Hospice of Michigan honor my advance directives?
Hospice of Michigan first recognizes advance directives incorporated in a Durable Power of Attorney for Healthcare. We then honor any other written directives, such as a living will. In the absence of written directives, we urge the surrogate decision-maker to consider preferences expressed verbally by the patient. We also consider information obtained at the time of admission and during the course of treatment whenever there is a question about patient care and the patient is unable to make the choice.

What happens if the surrogate doesn’t follow the advance directives?
If the hospice staff feels the surrogate is not acting in accordance with the patient’s expressed wishes, they will refer the case to an ethics committee. Patients and family members may also initiate ethics committee reviews. The committee provides guidance, recommendations and advice only. Treatment decisions are made by the patient (or surrogate) and the attending physician.

Are there other resources available to me?
HaveYouHadTheTalk.com offers a helpful toolkit to facilitate the important discussions necessary to prepare Advance Directives and is an easy way to eliminate the guesswork involved in the process.

For more information on Hospice of Michigan’s policy on medical treatment decisions, please call our Quality/Compliance department: 313-578-6273.