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Who will speak for you if you can no longer speak for yourself?

Information About Advance Healthcare Directive

An Advance Health Care Directive tells your doctor and your family what kind of care you would like to have if you are unable to make medical decisions.

When you are healthy, it's hard to think about the care you want if you become ill or are facing the end of your life. You should prepare this while you're healthy and thinking clearly, as it is important. It is best to complete this before a medical crisis.

An Advance Health Care Directive will relieve your family's stress. Knowing your wishes keeps them from struggling on their own about what you would like to have done. It keeps them from disagreeing about the best course of action.

     Consider This

     Things To Know

     How Do I Do This?

     Can You Change Your Mind?

     If You Do Not Have An Advance Health Care Directive

     Advance Directive Form

     Other Resources

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Consider this:

     * It's not just for older people. It is important for young people too, as they could be kept alive for decades in a condition they would not want.
     * Advance Health Care Directives aren't synonymous with "don't treat." Some people choose only to have their pain controlled when death is near, others want all possible treatments. It is your opportunity to let your family and physician know of your wishes.
     * You do not give up control of your health care decisions. Only when you are unable to communicate will the Advance Health Care Directive be followed.
     * You do not need a lawyer to make an Advance Health Care Directive.
     * You do not need a specific form. You can write your wishes down yourself. It has to include your signature and date, the signatures of two qualified witnesses. If you reside in a skilled nursing facility, the signature of the patient advocate or ombudsman is required.
     * It does not have to be notarized. Witnessed by two people is sufficient.
     * Your wishes do not have to be in writing, but it is very helpful if they are.
     * You do not have to have a surrogate decision-maker, but it is recommended. A surrogate decision-maker is someone you have chosen to make decisions for you if you are unable to make them for yourself.

Things to Know

     * Doctors and hospitals are obligated to follow your Advance Health Care Directive. In order to follow it, your physician and hospital must be aware of it. It is up to you to ensure that everyone who might need a copy of your Advance Health Care Directive has one.
     * If emergency medical services are called to any location outside an acute care hospital (such as your home or health care facility), they are required to resuscitate and stabilize patients until safely in a hospital. If you do not wish to have cardiopulmonary resuscitation (CPR), you must have a special "Pre-hospital Do-Not-Resuscitate" form. This form, which has to be signed by your doctor, protects you from having CPR.
     * Carry identification that includes where to easily obtain a copy of your Advance Health Care Directive.
     * Keep a ready copy of your Advance Health Care Directive at home along with a current list of medications and health conditions.
     * If you live in a skilled nursing facility or nursing home, the Long Term Care Ombudsman, or patient advocate, is required to witness your signature on your Advance Health Care Directive.

How do I do this?

     * Start with your doctor. Discuss the types of medical problems you may face based on your health and history. Your doctor can help you understand the treatment choices.
     * Think about your goals for medical treatment. It is impossible to plan for every medical event, but you can make your preferences for medical treatment clear .
     * Identify the quality of life you find acceptable.
     * Pick someone you trust to be your surrogate decision-maker. This should be someone who would be able to make tough decisions; who would speak up in a crisis situation; who understands your desires; and would speak for you when you are unable to speak for yourself.
     * If you choose more than one decision-maker, designate who will be first and who will be second.
     * You should have at least one alternate person, in case the first person is unavailable.
     * You can indicate if there is someone who you do NOT want to make your decisions for you.
     * If there are medical treatments you do not want under any circumstances, make that very clear in your Advance Health Care Directive. You have the right to refuse any medical treatment or surgery.
     * If you do not agree with the language in a pre-made form, change the language. Only sign a form after you are certain that it truly reflects your specific wishes.
     * You can write your wishes in your own words, but you have to be certain they can be clearly understood by others. You may want to go over this with your doctor, to be certain medical care providers can understand your wishes. As long as your wishes comply with the law, they will be followed.
     * Discuss your wishes with your surrogate decision-maker, your family and your doctor.
     * Sign the document in the presence of someone who is not your decision-maker; related to you by blood, marriage or adoption; will benefit from your estate; or is your healthcare provider. An unrelated friend, neighbor, or minister make ideal witnesses.
     * Be certain your wishes and instructions are clearly understood by all.
     * If you have a local hospital, give a copy of your Advance Health Care Directive for their files.
     * Give a copy to your physician and surrogate decision maker.

Can you change your mind?

     * In writing, tell your surrogate and your physician
     * Destroy all the copies of the old one, and create a new one.
     * Be sure a give a copy of the new one to your physician, surrogate, and hospital.
     * The Advance Health Care Directive with the most recent date is the legal one, and is the one that will be followed.
     * If you do not have time to put your changes in writing, tell your doctor, family and or friends who are present exactly what you want to happen. Wishes that are made in person will be followed in place of the ones made earlier in writing.

If you do not have an Advance Health Care Directive

Decision-making is left to someone else, generally a family member in order of kinship. This means decisions may be made by someone you may not have chosen.

An Advance Health Care Directive can give you peace of mind and will be appreciated by those caring for you and those who care about you.

Another option that may be helpful is the Physician Orders for Life-Sustaining Treatment (POLST). It is based on effective communication of patient wishes, documentation of medical orders, and a promise by health care professionals to honor these wishes. Please discuss this with your physician.

Other Resources

California Coalition for Compassionate Care

Riverside County Office on Aging

Long Term Care Ombudsman

Education for Life's Issues (ELI)
Call 951-845-8439

This information has been prepared for ELI: Education for Life's Issues

A non-profit community education program of San Gorgonio Memorial Hospital

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