HRRV recognizes that all persons have a fundamental right to make decisions relating to his/her own medical treatment, including the right to accept or refuse medical care. Encouraging individuals and their families to participate in decisions regarding care and treatment is the policy of HRRV. Valid advance directives such as Living Wills, Durable Power of Attorney for Health Care and Do Not Resuscitate (DNR) orders that are consistent with the scope of HRRV’s program will be followed to the extent permitted and required by law. Our staff will discuss advance directives with you and furnish copies of the documents for your convenience. You have the right to change your mind about any treatment or revoke an advance directive.
If you have a Living Will or Durable Power of Attorney for Health Care, please provide a copy of the document to the Hospice nurse or social worker. This will be kept in your Hospice medical records. Keep the original in a safe, accessible place and be sure that family members and the Hospice nurse know where to find it.
In the absence of advance directives, HRRV will provide appropriate palliative care according to the treatment plan authorized by the attending physician and the Hospice interdisciplinary team. HRRV will not condition the provision of care or otherwise discriminate against an individual based on whether or not he/she has executed an advance directive. However, should an individual wish to seek active treatment for his/her disease and or decide to receive cardiopulmonary resuscitation, the Hospice team will re-evaluate the appropriateness for hospice care.
HRRV does not require a DNR statement for admission into the program. Those patients who wish to enact a DNR order must receive a completed and signed order from the physician. The order must also be signed by your or your representative if you lack decisional capacity. HRRV recommends that copies of the DNR order be on file in your Hospice record, the physician’s record and at a location easily accessible and visible at your home or place of residence.
HRRV will use the following guidelines to determine whether an individual possesses decisional capacity in reference to executing advance directives and or DNR orders. An individual is presumed to have decisional capacity in the absence of actual notice to the contrary.
An individual with decisional capacity is:
- An adult (18 years or older or an emancipated minor)
- Able to understand and appreciate the nature and consequences of a decision regarding proposed treatment and alternatives to the proposed treatment.
- Able to reach and communicate informed decision/choice concerning treatment and/or end-of-life decisions.
Should the individual appear to lack decisional capacity, HRRV procedures for obtaining consent for treatment will be followed.
Hospice supports your rights as an individual to make decisions about your care that are consistent with your personal values.
Commonly Asked Questions
Q: What is an advance care directive?
A: An advance care directive is a written document or set of documents that is used to express your health care wishes when you are no longer able to personally communicate those wishes. Most advance care directives are comprised of 2 documents: a living will and a medical power of attorney.
Q: Why do I require an advance care directive?
A: Should you suffer from an accident or illness, you may not be able to communicate the type of treatment you wish to receive. In such circumstances, your health care provider and your family will be obliged to guess what your health care wishes are. However, if you have signed an advance care directive, your health care wishes will be clear and no guess work will be required.
Q: Do I need a lawyer to create an advance care directive?
A: No. An advance care directive can be created without the assistance of a lawyer. However, you may wish to consult an attorney for assistance.
Q: Do I need an advance care directive if I already have a last will and testament?
A: Yes. Advance care directives and wills are very different. Your last will and testament deals with the distribution of property after your death. In contrast, an advance care directive deals with your health and personal care and applies when you are alive and cannot communicate your wishes.
Q: What is a living will?
A: A living will allows you to convey your wishes regarding medical treatment when you are unable. Usually, a living will contains specific directions on the course of action you would or would not like to take if you are in a terminal condition, a permanent coma or in a persistent vegetative state. It may provide instructions on whether or not you wish to receive artificial life support, artificially administered food and water or comfort and care.
Q: What is a medical power of attorney?
A: A medical power of attorney allows you to designate someone to make health care decisions for you when you are unable. This type of document will authorize your health care representative to make decisions such as whether or not you wish to receive certain medical treatments or procedures. A medical power of attorney is sometimes referred to as a health care power of attorney or a health care proxy.
Q: If I have a durable power of attorney do I also need a medical power of attorney?
A: Durable powers of attorney and medical powers of attorney are both documents used to authorize someone to act for you after you have lost capacity or if you cannot communicate. However, a durable power of attorney allows an attorney-in-fact to make decisions relating to your property and finances while a medical power of attorney allows a health care representative to make decisions relating to your health. Consequently, you should have a medical power of attorney in addition to any durable power of attorney.
Q: Will my advance care directive be legally binding?
A: Once properly signed and witnessed, your advance care directive will be legally binding on family, friends and health care personnel (to the extent your directions are consistent with accepted health care practices). However, health care practitioners are not required to ask whether you have signed a directive or search for a directive. Make sure that your family, friends and health care representative know that you have signed an advance care directive and let them know where it can be found.
Q: Will my health care provider be obliged to follow the instructions in my advance care directive?
A: Generally, health care providers must follow your health care instructions (to the extent your directions are consistent with accepted health care practices). However, if a health care provider is unwilling to follow your directions, the provider is usually obliged to refer you to another health care provider who will honor your instructions.
Q: How long will an advance care directive last?
A: A health directive will last until the time of your death unless you have revoked it sooner.
Q: Who is the principal?
A: The principal is the person who will be requiring someone else to act for him or her. The principal must be an adult. The principal must be of "sound mind" and capable of making his or her own decisions at the time the advance care directive is executed (signed).
Q: Can anyone be a principal?
A: Anybody who is mentally capable and who is 18 years of age or older may make an advance care directive for themselves.
Q: Who is the health care representative?
A: The person appointed by the principal is called the health care representative. The health care representative is the person who acts for the principal in the event the principal is no longer able to communicate his or her wishes.
A health care representative may also be referred to as a proxy, an attorney-in-fact or an agent.
Q: Who cannot act as my health care representative?
A: Your health care representative should not be:
someone who is mentally incapable;
someone who is under 18 years of age;
a treating health care provider;
a non-relative employee of your treating health care provider;
an operator of a community care facility; or
a non-relative employee of an operator of a community care facility.
Q: Who do I choose to act as my health care representative (agent)?
A: Ensure that you choose an individual whom you trust and whom you feel comfortable sharing your wishes. It is not necessary to choose a health care representative who shares all your beliefs, however you should choose an individual whom you are confident will respect your wishes and who will do his/her best to get the type of health care treatment you want.
It is important to choose a health care representative who will be available when required to make your health care decisions. There may come a time where you require someone to remain by your bedside for long stretches of time to ensure health care personnel follow your wishes. Under these circumstances, it may not be practical to have a representative who resides out of state.
You should discuss your health care wishes with your heath care representative to ensure that he or she will be able to make decisions based on what you have discussed and the information contained in the directive.
Q: Do I need to appoint a successor health care representative (agent)?
A: You do not need to appoint an alternate health care representative however it is a good safeguard. Should your original representative be unable or unwilling to act on you behalf, your successor representative (agent) could act for you instead.
Q: When will my representative be allowed to make my health care decisions?
A: Your representative can only make your health care decisions after a doctor has determined that you are unable of making or communicating responsible health care decisions for yourself.
Q: What will happen if I appoint my spouse as my representative and we later divorce?
A: Generally, your spouse’s authority to act on your behalf will be revoked on your divorce unless you specify something to the contrary in the directive. If you had named an alternate representative, then that person will now have authority to act on your behalf. However, it is usually best to create a new advance care directive after a divorce to ensure that your intentions are clear.
Q: What is a "health care provider"?
A: A health care provider is any person who is licensed, certified or otherwise legally authorized to administer health care in the ordinary course of business or practice of a profession.
Q: What is an "attending physician"?
A: An attending physician refers to the physician licensed by the state board of medicine, selected by or assigned to the patient, and who has primary responsibility for the treatment and care of the patient.
Q: Can I change or alter my advance care directive?
A: If you wish to alter the directions in your advance care directive or appoint a different health care representative, you should destroy all copies of the directive and create a brand new directive. Remember that your directive should always reflect your current wishes. Also, ensure that you provide a copy of your new directive to your health care representative, your physician or anyone else who had received the old directive.
Q: Can I revoke my advance care directive?
A: If you wish to revoke your advance care directive, the best way to do so is by destroying all copies of the directive and notifying your health care provider of your decision. You may also revoke your directive by informing your attending physician or health care provide that you wish to revoke your directive. Generally, a revocation of a health care power of attorney will only be accepted if the revocation was made while the principal was of sound mind.
Q: Do I require a new advance care directive if I move to another state?
A: Each state has its own laws, forms and procedures related to health care directives. Most states will honor the advance care directive of another state however it is best to consult with the legislation specific to your state to ensure that your directive will be recognized.
Q: What should I do with my advance care directive once it has been properly signed and witnessed?
A: You should discuss your advance care directive with your health care representative, your family and your family physician. Additionally, you should provide these parties a copy of your directive.
Q: Who can act as a witness?
A: Your Power of Attorney for Health Care must contain verification of your signature (or the signature of a person authorized by you to sign on your behalf). The verification can usually be made by either a notary public or by a witness.
B: Living Will – Your Living Will must be signed by you and two witnesses over the age of 18. Your witness cannot be a health care provider, an individual who works for a health care provider, a person you have designated as your agent or alternate agent (health care representative); or a person who is entitled to any part of your estate on your death, either in your will, or by the laws of intestate succession (a person who is your heir).
Q: Are there any other witnessing formalities?
A: Power of Attorney for Health Care - Your witness must watch you sign or be present when you acknowledge your signature.
Living Will – Both witnesses must be present to witness your signature and they must watch each other sign.