Advance Directives

Advance Directives are tools people may use to convey medical wishes.

Serious illness and end-of-life issues are not easy to talk about. However, making medical care decisions in advance makes the situation easier on your family and loved ones. If decisions are not made in advance, your wishes will not be known and treatments may be provided that you do not want.

Advance Directives are legal planning tools that help you make your wishes known. In Ohio, we have 5 Advance Directive tools:

  • Living Will
  • Durable Power or Attorney for Health Care
  • Do-Not-Resuscitate (DNR) Comfort Care Order
  • Mental Health Declarative
  • Organ Donation

Learn more about these tools, how to create them, and how valuable they can be to both you and your family by clicking on each tool.

Planning Option What does
it do?		 Benefits Who completes? When is
it needed?
Living Will Gives instructions on the care or treatment you wish if you become terminally ill or permanently unconscious and cannot communicate your wishes. Gives your family and physician in a legal written format, direction for your care. Provides legal removal of life-support mechanisms. You (using the state tool) When you become terminally ill or permanently unconscious with no hope of recovery and cannot communicate your wishes.
Durable Power of Attorney for Health Care Grants someone to be in charge of your medical decision making when you are unable to communicate your wishes. Gives health care workers and physicians a legal person of authority to communicate with and receive decisions from. Speeds up the medical decision making process. You (using the state tool) When you are unable to communicate your own medical wishes.
Do-Not-Resuscitate A physician order that directs medical personnel to not provide cardiopulmonary resuscitative measures (CPR). DNR orders are given when there is medical reason to not provide CPR, i.e. terminal illness, or end of life is near. This is not a tool used for the healthy adult to prepare for future illness Gives clarification to the healthcare providers regarding treatment and care to provide. Focus becomes on comfort care measures only. Your Physician Near death or terminal illness
Mental Health Declarative Grants someone to be in charge of your mental health decision-making when you are unable to communicate your wishes. Gives health care workers and physicians a legal person of authority to communicate with and receive decisions from. Speeds up the medical decision making process. You (using state tool) When you are unable to communicate your own mental health wishes.
Organ Donation Allows you to choose organs or tissues you would like to donate upon your death Provides organ procurement agencies and family instructions on your wishes. You (through Ohio BMV register) After death

 

Who Needs to Know?

After completing any of the above planning tools, it becomes important to communicate to your family members that these tools exist and your medical care wishes. The Living Will, Durable Power of Attorney for Health Care, and Mental Health Declarative also need discussed with your physician. Your physician will discuss the DNR with you, if it is appropriate based on your health condition. When you enter Morrow County Hospital we will ask you if you have any of these Advance Directives (except for Organ Donation), and we will ask for a copy to put on your medical chart. Along with informing others about your medical care wishes and the forms that you have completed, let family know where you will keep the original form.

Frequently Asked Questions

  1. If I have a Living Will, do I need a Durable Power of Attorney for Health Care also?
    Many people will want to have both documents because they address different aspects of your medical care. A Living Will gives your instructions directly to your physician and it only applies when you are terminally ill or permanently unconscious and cannot communicate your wishes. A Durable Power of Attorney for Health Care covers a wide range of health care decisions – like surgical consent or changing physicians – that do not require a patient to be dying. The proxy acts on your behalf to make medical decisions only when you are unable to communicate for yourself.
  2. If I have a Living Will that indicates that I do not want life-sustaining measures when I am terminally ill or permanently unconscious, would I still get medication for my pain?
    Yes. A Living Will only affects care that artificially or technologically postpones death. It would never affect care that eases pain. For example, you would continue to receive oxygen, pain medication, and any care that would provide you comfort.
  3. Who makes the decision that I am dying or permanently unconscious without hope of recovery?
    Two physicians must agree that there is no hope of recovery and the only thing that is sustaining your life is of artificial means.
  4. A Living Will may be important for a senior citizen, but why should this be a priority for someone in their twenties?
    A Living Will is designed to give you and your family peace of mind whether you are 25 or 75 years old. If you do not want life-sustaining measures when you were terminally ill or permanently unconscious than a Living Will is the legal document that you need to make that happen, regardless of being 25 or 75 years old.
  5. My mother is in a nursing home. If she appointed me proxy of her Durable Power of Attorney for Health Care, would this allow me act on her behalf in every area affecting her health care?
    Yes, as long as she is unable to communicate her own wishes.
  6. Do I have to use the standard state forms for a Living Will and Durable Power of Attorney for Health Care or can I draw up my own documents?
    In order for either form to be valid, it must include specific language spelled out in the Ohio Revised Code. The state forms include this language.
  7. What if I change my mind regarding my Living Will wishes?
    Documents can be changed to reflect new wishes or documents can be destroyed. However, when your wishes change you need to notify those individuals/organizations that know of your wishes of this change. They will not know of your change in wishes until you inform them of such.
  8. Can I have a Durable Power of Attorney for Health Care and a Mental Health Declarative?
    Yes, the documents deal with two separate issues, one medical and one mental health. However, if you have both forms with two different proxies it could become complicated as to who makes what decision. Make sure they understand their role in decision-making.
  9. Can I make myself a Do-Not-Resuscitate?
    No. Only a physician can make someone a DNR based upon medical justification. If you are terminally ill, your physician will discuss this option with you.
  10. When I enter a hospital is my care dependent upon my organ donation wishes?
    No. The hospital is not aware of your organ donation wishes when providing you care. It is not until your death or imminent death that organ donation preferences are sought. Only authorized organ, tissue and eye recovery agencies have access to the Ohio Donor Registry.

Additional Information:

Living Will

A Living Will is a legal written document that allows you to state in advance your medical wishes related to end-of-life care.

The Living Will gives direction specifically regarding the use of life-sustaining treatments, including mechanical ventilation and artificially supplied nutrition and hydration.

The Living Will applies when you are determined to be terminally ill or permanently unconscious and two physicians agree that there is no hope of recovery. The only thing sustaining life is the mechanical treatments. If you have a Living Will and are deemed terminally ill or permanently unconscious you would receive comfort care measures only; any treatments prolonging life would be withdrawn. The Living Will only comes into effect with terminal illness or permanent unconscious states, you would receive medical care as usual to treat illness or injury. You can be update, revise or destroy your Living Will.

After completing the Living Will, the person should give a copy to their primary care physician, local hospital and family members. Living Wills that are not communicated to others may not be known to the healthcare providers in the medical situation. In order for your Living Will wishes to be honored, you must communicate its existence and your wishes to others.

Durable Power of Attorney for Health Care

A Durable Power of Attorney for Health Care is a legal written document that allows you to appoint in advance of medical crisis who you want making medical decisions on your behalf if you become unable to communicate your medical wishes. You may appoint a primary person with two alternatives. Those appointed should be family, close friends, or those people that are with you at the time of medical treatment or hospitalization.

The proxy appointed has authority to direct all medical care: change physicians, give consent to treatment, nursing home placement. However, this is only when you can not communicate or make decisions on your own. Potentially you could be able to make your own decisions one day, have a stroke and be unable to communicate your wishes the next (Durable Power of Attorney for Health Care making decisions), recover from the stroke and be back to making your own decisions.

Durable Power of Attorney for Health Care documents should be shared with your primary care physician, local hospital, and those appointed on the form. If this document is not communicated, your wishes may not be honored because no one knows your wishes. Communication is the key to your wishes being known and followed.

Do-Not-Resuscitate (DNR) Comfort Care

Do-Not-Resuscitate Comfort Care is a physician order that directs healthcare workers and emergency medical personnel to not provide cardiopulmonary resuscitation measures (CPR).

This physician order is only an option if you have medical reason to be a Do-Not-Resuscitate, such as a terminal illness or limited life expectancy. A DNR is not a document that a physician will complete for you if you are a medically healthy person.

For more information, if you are terminally ill or have limited life expectancy, you should discuss this with your family physician.

Mental Health Declarative

A Mental Health Declarative is a legal document that allows you to state in advance who you would appoint to make mental health decisions on your behalf if you become unable to communicate due to medical illness or mental status.

This declarative works just like the Durable Power of Attorney for Health Care, except it is for mental health decision making. Refer to Durable Power of Attorney for Health Care link.

Organ Donation

In Ohio, you can make your organ donation wishes known through the Bureau of Motor Vehicles (on driver’s license or state identification card) or by completing a form within the Living Will. Either process gets you registered on the Ohio Donor Registry. Organ donation wishes are not known by your healthcare providers unless death has occurred or is very near.

Organs that can be donated include the heart, kidneys, lungs, liver, pancreas or small bowel. Tissues that can be donated include bone, heart valves, ligaments, veins, skin and the corneas of the eye.

The organs/tissues are recovered for transplantation in end-stage organ failure from those individuals on the Ohio Donor Registry. Your status as an organ and tissue donor is only considered after every effort has been made to save your life and you have been declared legally dead. Your medical care is never affected by your wishes for donation.

Organ donation is an anonymous process that ensures your gift will go to the person(s) who needs it most. There are no age limits for organ donation; persons less than 18 years of age must have consent of the parent or guardian to donate.