Advanced Directives Learn about your rights as a patient and need to know information about your choices for care. Advance Directives What do I need to know? You can decide, right now, what medical treatments you want or don’t want. You can tell your doctor or loved ones these decisions so that if you become too sick to tell them they will know what you want them to do. You can choose someone you trust to make these decisions for you if you become unable to make them for yourself. You can write these decisions down on a paper called an advance directive. What are my choices? You can decide, right now, what medical treatments you want or don’t want. Advance directives are documents you can complete to protect your rights to determine your medical treatment and can help your family and doctor understand your wishes about your health care. Your advance directive will not take away your right to continue to decide for yourself what you want. This is true even under the most serious medical conditions. Your advance directive will speak for you only when you are unable to speak for yourself, or when your doctor determines that you are no longer able to understand enough to make your own treatment decisions. Putting Wishes into Writing The State of Indiana recognizes seven (7) type of advance directives: Living Will - A “living will” is a written document that puts into words your wishes in the event that you become terminally ill and unable to communicate. A living will is an advance directive that lists the specific care or treatment you want or do not want during a terminal illness. A living will often includes directions for CPR, artificial nutrition, maintenance on a respirator and blood transfusions. This document is used to tell your physician and family that life-prolonging treatments should not be used so that you are allowed to die naturally. Your living will does not have to prohibit all life-prolonging treatments. Your living will should list your specific choices. For example, your living will may state that you do not want to be placed on a respirator but that you want a feeding tube for nutrition. You may even specify that someone else should make the decision for you. Psychiatric Advance Directive - Any person may make a psychiatric advance directive if he/she has legal capacity. This written document expresses your preferences and consent to treatment measures for a specific diagnosis. The directive sets for the care and treatment of a mental illness during periods of incapacity. Health Care Representative - A “health care representative” is a person you choose to receive health care information and make health care decisions for you when you cannot. Your health care representative may agree to or refuse medical care and treatments when you are unable to do so. Your representative will make these choices based on your advance directive. If you want, in certain cases and in consultation with your physician, your health care representative may decide if food, water, or respiration should be given artificially as part of your medical treatment. The advance directive naming a health care representative must be in writing, signed by you, and witnessed by another adult. Power of Attorney - A “power of attorney” (also referred to as a “durable power of attorney”) is another kind of advance directive. This document is used to grant another person say-so over your affairs. Your power of attorney document may cover financial matters, give health care authority, or both. By giving this power to another person, you give this person your power of attorney. Your power of attorney document must be in writing and signed in the presence of a notary public. Out of Hospital “Do Not Resuscitate” Declaration and Order - In a hospital or health facility setting, if you have a terminal condition and you do not want CPR, your physician will write a “do not resuscitate” order in your medical chart. If you are home when an emergency occurs, there is no medical chart or physician's order. For situations outside of a hospital or health facility, the “Out of Hospital Do Not Resuscitate Declaration and Order” is used to state your wishes. Organ and Tissue Donation - Increasing the quality of life for another person is the ultimate gift. Donating your organs is a way to help other's. Making your wishes concerning organ donation clear to your physician and family is an important first step. Talking To Your Physician and Family - One of the most important things to do is to talk about your health care wishes with your physician. Your physician can follow your wishes only if he or she knows what your wishes are. By discussing your wishes with your physician, your physician will record your choices in your medical chart so that there is a record available for future reference. If you have written an advance directive, it is important that you give a copy to your physician. Can I make my own medical decisions? Unless you do something, your health care decision will be made by someone else if you become unable to consent to or refuse your medical treatments for yourself. In Indiana, these decisions may be made by whomever your doctor talks to in your immediate family (meaning your spouse, parent, adult child, brother or sister) or by a person appointed by a court. But in Indiana, you can make and write down your own decisions about your future medical treatment if you wish. Or you can appoint a person you choose to make these decisions for you when you are not able to do so. You can even disqualify someone you don’t want to make any health decision for you. You can do these things by having what is called and advance directive. What Can I do now to express my wishes in case I later become unable to tell my doctor or my family? You have three ways you can make your wishes known: You can speak directly to your doctor and your family. You can appoint someone to speak or decide for you. You can write some specific medical instructions. Can I change my mind after I write an advance directive? Yes. You can change your mind about any of the types of appointment or about the living will. However, you need to make various people aware that you’ve changed your mind - like your doctor, your family or the person you’ve appointed and - you might have to revoke your decision in writing. Remember, however, that you can always speak directly to your doctor. Be sure to state your wishes clearly and be sure they are understood. What if I make an advance directive in Indiana and I am hospitalized in a different state, or vice versa? The law on honoring an advance directive in or from another State is unclear. Because an advance directive tells your wishes regarding medical care, however, it may be honored wherever you are, if it is made known. But if you spend a great deal of time in more than one state, you may wish to consider having your advance directive meet the laws of those States, as much as possible. What should I do with my advance directive if I choose to have one? Make sure that someone, such as your lawyer or family member knows that you have an advance directive and know where it is located. You should give a copy of your power of attorney document to the person you have appointed to serve as your attorney in fact. You may also decide to ask your doctor or other health care provider to make your advance directive a part of your permanent medical record. Another idea would be to keep a second copy of the directive in a safe place where it can easily be found. You might keep a small card in your purse or wallet which states that you have an advance directive and where it is located or who your attorney in fact is, if you have named one. Will I be refused care if I have an advanced directive? No. No treatment will be withheld or stopped until your doctor determines that treatment wouldn’t benefit you as you'd wish.