Durable Power of Attorney for Health Care
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.
Who can witness the Durable Power
of Attorney for Health Care 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
health care 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 Hospice of Michigan's
administrative office at (313) 578-5000. 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.
What does a surrogate do?
He or she will 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 health care issues. You can help the
surrogate by learning as much as you can about the choices that may have to be made
and by telling your surrogate about your values and preferences.
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 health care
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 to find them.
You should review your advance directives periodically and change
them as necessary. When you are admitted as a patient by a hospital or health care
agency, you will be asked if you have completed advance directives. You should give
the admissions officer a copy so it can be placed in your medical record.
You can also request a copy by calling Hospice of Michigan's
administrative office at (313) 578-5000. 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 Health Care. Then, it honors any other written directives,
such as a living will. In the absence of written directives, the staff urges the
surrogate decision-maker to consider preferences expressed verbally by the patient.
The staff also considers 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.
For more information on Hospice of Michigan's policy on medical
treatment decisions, contact the Quality/Compliance department: (313) 578-6221.
