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Advance Directive Form
|Every person has the right to make decisions about their medical care. This is the law and it includes the right of a person, or his or her family, to control the decisions relating to their own medical care, including the decision to have life-sustaining procedures withheld or withdrawn in instances when the person is diagnosed as having a terminal or irreversible condition.|
Life support measures can cause loss of dignity while offering an uncertain and difficult future. St. James Parish Hospital recognizes and respects the rights of people with a terminal and unchangeable condition even after they cannot participate in the decisions about their health and medical care. An advance directive is a legal paper that describes the medical treatment you would choose if you were ever in such a situation.
Living wills are written instructions that explain your wishes for health care if you are dying or are in an irreversible coma and unable to state your wishes.
Decision-making power given to default decision-makers, who are usually family members in order of kinship, should the patient be comatose, incompetent or otherwise physically or mentally incapable of communication provided that a patient has not previously made a declaration.
- Advance Directives By Others
Durable power of attorney is a document that lets you specifically designate a person to make medical decisions for you if you become unable to do so. And the document expressly authorizes this person to make medical decisions regardless of your mental and physical capabilities.
- Durable Power of Attorney
State and federal laws require hospitals to give you information about advance directives. We must also tell you our policy for carrying out your advance directive.
If you need more information, please ask one of our staff to help you.
Who Can Have an Advance Directive?
As an adult, you can at anytime, write wishes and instructions for your doctor. However, the following guidelines are important:
- The written statement must be signed by you, in front of two witnesses. The witnesses must also sign.
- The witnesses must be competent adults who are not entitled to any part of your estate and/or not related by blood or marriage at the time of your death.
- A person can make an oral or nonverbal declaration in the presence of two witnesses (as described above) only AFTER he or she has been diagnosed with a terminal condition.
Responsibility to Inform the Doctor
You are responsible for letting your doctor know that you have an advance directive. If you become mentally or physically unable to communicate, any other person may let the doctor know about your advance directive. It is important to give your doctor a copy of your advance directive and to provide a copy whenever you are admitted to the hospital.
Can Anyone Else Make An Advance Directive for Me?
If an adult has not made an advance directive and is incapable of making such a decision, the law gives the following persons in the following order of priority, the right to make a declaration on an adult patient’s behalf to withhold or withdraw life-sustaining procedures should the patient be comatose, incompetent, or otherwise physically or mentally incapable of communication and be diagnosed and certified as having a terminal and irreversible condition or be in a continual profound comatose state with no reasonable chance or recovery.
- Any person previously designated by the patient. (Durable Power of Attorney)
- The court-appointed guardian of the patient. (If there is no Power of Attorney)
- The patient’s legal husband or wife. (Living spouse and there is no Power of Attorney.) (Louisiana does not recognize common law marriages.)
- The patient’s adult children, together. (If there is no legal spouse.)
- The patient’s parents, together. (If there are no children or spouse.)
- The patient’s brothers and sisters, together. (If the parents are deceased.)
- The patient’s grandparents/great grandparents or grandchildren/great grandchildren. (If there is no legal spouse, parents, adult children or siblings.)
The statement “together” means that the decision must be unanimous, or agreed upon, by everyone in that group that is reasonably available for consultation. AND at least two witnesses, as described above, must be present at the time the decision is made.
What About a Minor?
If a minor, or child under the age of 18 is diagnosed with a terminal illness or condition with no hope of recovery, the following persons may decide about life support measures:
- The legal spouse of the minor, if the child has been emancipated and the spouse is over the age of 18.
- If there is no spouse, or he/she is not available, or he/she is underage, either the parent or guardian of the patient.
This type of advance directive must be signed by the person making the decision in front of two witnesses, as described above. The witnesses must also sign. However, a person cannot “speak” for the minor if he or she has information from the patient that contradicts the decision. A person cannot “speak” for the minor, as a parent or guardian, if he or she knows that the other parent or guardian or spouse (of legal age) disagrees.
Appointing Another Person
If you do not wish to make a treatment decision or complete a living will while you are competent to do so, you may appoint another person to decide for you. To do this you must complete a “Durable Power of Attorney” form (the person you choose does not have to be a lawyer). You must sign and date this statement and also have two witnesses sign. The Power of Attorney is only invoked if you become incapacitated or incompetent to do so.
• Keep a card in your wallet stating you have an advance directive and where to find it.
• Give a copy to your doctor.
• If you use a durable power of attorney, give your proxy and physician a copy, too.
• Discuss your advance directive with family and friends or anyone who might be called in an emergency.
• Renew your advance directive regularly, make changes as necessary.
• You may add information to your living will in the area above your signature. For example:
Tissue or Organ Donation: “If any of my tissues or organs are sound and would be of value as transplants to other people, I freely give my permission for such donations.”
• Be sure to give copies of any changes to your doctor, family, proxy or anyone else who might be called in an emergency.
• Take a copy to the hospital whenever you think you might be admitted.
• Keep a copy in your home, in plain sight, for any emergency personnel.
Does an Advance Directive Affect Insurance?
NO. Louisiana law provides that an advance directive cannot affect your ability to receive life insurance or change the terms of any insurance policy, regardless of what the policy may say.
The law also states that if life support is removed, according to your advance directive, death cannot and will not be considered suicide. Most major religions also do not consider this a suicide. If you are in doubt, contact your pastor or clergy person.
Can an Advance Directive Be Cancelled?
YES. Louisiana law provides that an advance directive can be taken back or cancelled at any time by the person who made it, without regard to his or her mental state or competency. Your advance directive can be cancelled by any one of the following methods:
• By being cancelled, defaced, damaged, burned, torn or otherwise destroyed by you or someone else in front of you and at your direction.
• By writing a statement that cancels the original decision and signed it, with the date listed.
• By stating your wishes or indicating them by unspoken gestures.
Before making any decisions, we urge you to talk with your doctor, lawyer, clergy and family. Our staff can assist you in reaching clergy or social workers.
Blank documents of a Living Will, Advance Directive on Behalf of an Incompetent Patient who has not Previously Made a Declaration and Durable Power of Attorney are available. Please ask the nurse or physician for the appropriate form.