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    Who Decides, and When? - Understanding Advance Directives.

    Deaconess Religious Life 04/16/2021

    Here at Deaconess, patients and family members are making decisions on others’ behalf every single day.  Sometimes the situation is sudden, such as after a car crash. In other situations, a family member has been in a gradual decline. But in all circumstances it can be a difficult time, so having the right information, with the desired decision-makers, is very important.

    Common Advance Directives / Health Care Legal Terms:

    • Healthcare Representative – This is the most common form that we work with here at Deaconess.  A health care representative is a person who has been designated as the health care decision-maker on another’s behalf. This designation must be a written declaration that is either presented in-person or is on-file in a person’s electronic medical record here at Deaconess.
    • Living Will: A living will is a written document declaring a person’s wishes if he/she is in a terminal condition.
    • Life-prolonging Procedures Declaration – This is an advance directive that tells health care providers everything a person wants done to prolong life.
    • POST form – Physician Order for Scope of Treatment – it’s a “portable” form that someone with a serious/chronic illness can keep with them to ensure that their wishes will be honored by providers in an ambulance, emergency department, hospital, nursing home, etc.
    • Power of Attorney (POA): A POA is a legally-designated person who can handle financial and legal aspects on behalf of another person. This designation sometimes includes making medical decisions on another’s’ behalf, but not always.
    • Guardianship – This is a court-ordered/declared position that is given to a person who oversees decisions and care of another person who does not have the ability to do so themselves.

    Healthcare Representative
    A healthcare representative is a person who has been designated as the health care decision-maker on another’s behalf. The patient has to make this designation themselves—ahead of time. This role can be needed for unanticipated emergencies—such as a car accident or sudden illness. It can also be helpful for someone who has a chronic condition.
    In the state of Indiana, if you are unable to make decisions for yourself and you don’t have a health care representative, first-degree relatives make decisions on your behalf. That means your spouse, parents, adult children and adult siblings all have input - but there is an order:
    1. Guardian
    2. Spouse
    3. Adult Child
    4. Parent
    5. Adult Sibling
    6. Grandparent
    7. Adult Grandchild
    8. Adult Friend
    9. Nearest other adult relative in the next degree of kinship not previously listed (Aunt, Uncle, Niece, Nephew, etc.)

    Sometimes this can work out just fine. In families where everyone knows what the patient would want, a health care representative isn’t always needed. But for some families (as you can imagine) this doesn’t always go well, and so having a declared health care representative can be crucial to ensure the patient’s wishes will be honored.
    A healthcare representative is declared via a legal form (simple to fill out) and should be presented to a health care provider to add to the person’s medical record. We keep those forms here at Deaconess.  They’re also available at any family law attorney’s office, as well as online at the Indiana Department of Health Advance Directives Resource Center. When the form is signed, it must be witnessed by someone who can state that the person is voluntarily designating.  The form does not need to be notarized.
    Living Will, Life-Prolonging Procedures Declaration
    A living will is a written legal document declaring a person’s wishes if he/she is in a terminal condition.
    This means that if a person has developed a condition, or an illness has progressed, or a serious health event has occurred that will lead to the person’s death in the near future, this document will help physicians, other providers and family members know what the patient does and does not want done on their behalf. This document isn’t in effect or even considered until a physician certifies in writing that the patient’s condition is terminal and that medical care will only prolong the dying process.
    A living will indicates that a person does not want extreme measures taken. There is also the option to declare wishes regarding nutrition/hydration if the person is no longer able to eat or drink on their own.
    A life prolonging procedures declaration states that a person DOES want everything done as long as possible in the event of a terminal illness or condition.
    These documents must be in writing, and submitted to a person’s physician and care providers.  Again, these forms can be found online at the Indiana Department of Health Advance Directives Resource Center. The forms need to be witnessed by someone who knows the person and knows they’re completing the form voluntarily.
    POST Form
    POST form – Physician Order for Scope of Treatment – ensures that a patient’s wishes are honored by providers at any point of care. For example, if a person is near the end of their life, and they don’t ever want to be resuscitated (CPR or other means), they can have their doctor complete a POST form so that in the event of being in an ambulance, emergency department, etc. the patient knows he/she will have their wished honored.
    A POST form can include other directions that can prolong life and/or provide comfort care. It’s a very customizable form because it’s completed by a doctor. This is a great conversation to have with your physician. For more information about the form, visit the Indiana Department of Health Advance Directives Resource Center. Sample forms are on the page.
    Power of Attorney, Guardianship
    A power of attorney (POA) and guardianship are both non-healthcare-related statuses; however, they can sometimes overlap into healthcare.  They are not specific to medical situations, but are related to other legal/financial issues. For example, if someone has a POA to handle all their financial and legal matters, that POA form must also declare them to be the healthcare representative if the patient wants them to make health care decisions on his/her behalf.
    If the POA form doesn’t mention health care representation, then the POA does not have that authority.  The decision rests with the patient, or if he/she can’t communicate, it goes back to their first-degree relatives, or a separate healthcare representative.
    A guardianship is a role declared by a court, when a person is unable to make their own decisions.
    Patients Make Their Own Decisions As Long As They Are Able
    There is sometimes confusion that a person who is POA or health care representative can always make a patient’s decisions for them. But if the patient still has the ability to make their own decisions, and can communicate them in any way, we will turn to the patient for the decision.
    Also, sometimes people say that they are POA, guardian, health care representative, etc. but we must see valid documentation of this.  We cannot “take someone’s word for it.”
    Know What YOU Want, Then Put It In Writing
    Know what you want, who you want to speak on your behalf if necessary, and then put it in writing and give it to your doctor/hospital. Also, if you have your documents already, and you would like them on file here at Deaconess, you can bring them in-person to our Medical Records department located at Deaconess Hospital.  It’s near the front doors of the hospital, and is open Monday - Friday during regular business hours. Your forms can be scanned and entered into your electronic medical record. Your Deaconess physician’s office can also complete this scanning.


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