Why you need a living will
AN APPLE A DAY - Tyrone M. Reyes M.D. () - November 2, 2010 - 12:00am

Hospital care is complex and requires many choices and decisions. This complexity can be confusing and even frightening for patients at a time when they need to make important decisions and focus on coping with their illness.

Today’s article is designed to help you learn more about Health-Care Directives (Living Will) to make sure your wishes about medical care are followed in the event you become unable to speak for yourself. It also covers treatment concerns such as Cardiopulmonary Resuscitation (CPR) and Do Not Resuscitate (DNR) status for patients. At the end of this article is a sample Health-Care Directive form which you or your lawyer may use as a guide to make your own Advance Directive.

Advance directives

Some medical conditions permit the extension of life for many years through artificial means. But many patients and their families question the value of doing so where there is little hope of recovery.

The quality of life during and after recovery from an illness is often an important issue. Consider quality-of-life issues in making decisions about accepting, rejecting, or stopping medical treatment. For instance, ask yourself the following questions:

1. If terminally ill or permanently unconscious, would you wish to have your heart restarted if it stops?

2. How much medical treatment do you wish to have if you develop a terminal condition or are permanently unconscious?

3. Who should make decisions for you if you are not able to express your wishes?

Your doctor and the hospital would like to respect your wishes. But first, they need to know what your wishes are. Advance directives are written, legally-recognized documents that state your choices about health-care treatment or name someone to make such choices for you if you are not able to do so. And as a patient, you have the option to review and revise your advance directives, as needed.

Health-care directives (living will)

This is a living document that allows a person to state whether he or she wants his or her life artificially prolonged under certain conditions. The Health-Care Directive would only be followed if the patient is diagnosed in writing by the attending physician to be in a terminal condition or in a permanent unconscious situation by two doctors, and where the application of life-sustaining treatments would serve only to artificially prolong the process of dying. The Health-Care Directive must be signed by the patient and witnessed by two persons. The witnesses cannot be related to the patient or expect to inherit anything from the patient and they cannot be hospital employees, staff, attending doctors or employees of the attending doctor.

When a patient is unable to talk or let us know what he or she wants, another person must be prepared to make decisions about his or her medical care. If you are given the responsibility through kinship or legal relationship, please tell the patient’s doctor or nurse right away. Before using your authority to provide informed consent for a patient, you must first agree (if possible) that the patient, if he or she were able, would have agreed to the treatment plan. Otherwise, the decision may be made after determining that the proposed care is in the patient’s best interest.

Cardiopulmonary resuscitation (CPR) and do not resuscitate (DNR)

A sudden stopping of the heart can cause unexpected death. But it can also be the natural end and painless release from a chronic, painful illness. CPR is a series of measures performed to prevent death when a sudden collapse occurs because the heart stops.

CPR has the greatest chance of being completely successful when the heart stops suddenly in an otherwise healthy person. When CPR is attempted on elderly patients, or those who have many medical problems, it is less likely to be effective. CPR success rates vary depending on your medical condition and should be discussed with your doctor. In general, success rates are much lower for people who are sick enough to be in the hospital. It is the policy of hospitals to perform CPR on all patients whose hearts stop suddenly unless a doctor writes an order not to resuscitate (DNR).

You and your family are encouraged to talk with your doctor about your wishes concerning CPR. It is very important to know your wishes when you are admitted. You may request to have a DNR or your doctor may write an order, when in his or her medical judgment, initiating CPR would clearly be futile. If your doctor writes a DNR order because he or she believes CPR would not be beneficial or in your best interest, then he or she must inform you and/or your family first to seek your permission.

Sample health-care directive

It is helpful to talk with those you are close to when making decisions about advance directives. It may also be helpful to seek advice from an attorney. If you do decide to make one, it is important to talk to your physician and ensure that a copy is provided for in your medical chart.

Here is a sample of a health-care directive:

Directive made this day               of               (month, year).

I,                                  (name), having the capacity to make health-care decisions, willfully and voluntarily make known my desire that my dying shall not be artificially prolonged under the circumstances set forth below, and do hereby declare that:

(a) If at any time I should be diagnosed in writing to be in terminal condition by the attending doctor, or in a permanent unconscious state by two doctors, and where the application for life-sustaining treatment would serve only to artificially prolong the process of my dying, I direct that such treatment be withheld or withdrawn, and that I be permitted to die naturally. I understand by using this form that terminal condition means incurable and irreversible condition caused by injury, disease, or illness that would within reasonable medical judgment cause death within a reasonable period of time in accordance with accepted medical standards, and where the application of life-sustaining treatment would serve only to prolong the process of dying. I further understand in using this form that a permanent unconscious condition means an incurable and irreversible condition in which I am medically assessed within reasonable medical judgment as having no reasonable probability of recovery from an irreversible coma or permanent vegetative state.

(b) In the absence of my ability to give directions about the use of a life-sustaining treatment, it is my intention that this directive shall be honored by my family and doctor(s) as the final expression of my legal right to refuse medical or surgical treatment and I accept the consequences of such refusal. If another person is appointed to make these decisions for me, I request that the person be guided by this directive and any other clear expressions of my desires.

(c) If I am diagnosed to be in a terminal condition or in a permanent unconscious condition (check one):

• I DO want to have artificially provided nutrition and hydration.

• I DO NOT want to have artificially provided nutrition and hydration.

(d) If I have been diagnosed as pregnant and that diagnosis is known to my doctor, this directive shall have no force or effect during the course of my pregnancy.

(e) I understand the full import of this directive and I am emotionally and mentally capable to make the health-care decisions contained in this directive.

(f) I understand that before I sign this directive, I can add to or delete from or otherwise change the wording of this directive and that I may add or delete from this directive at any time and that changes shall be consistent with Philippine laws to be legally valid.

(g) It is my wish that every part of this directive be fully implemented. If for any reason any part is held invalid, it is my wish that the remainder of my directive be implemented.

Patient Signature              Date              Address

Printed Name      Date of Birth

The declarer has been personally known to me and I believe him or her to be capable of making health-care decisions.

Witness Signature          Date   Witness Signature   Date

Printed Name                           Printed Name

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