Advance Directives
The material presented related to advance directives is for informational purposes only, and should not be considered legal advice or used as legal advice. On all these matters, you should consult your own attorney. Jennie Stuart Health takes no position on whether a person should execute an advance directive.
Advances in modern medicine have saved and prolonged many lives. However, these advances have raised many questions about using machines to prolong the natural dying process for terminally ill patients. Individuals are now more frequently asking how they can have more control over their medical care at the end of their lives.
It Is Your Decision
On December 1, 1991, a federal law went into effect that requires hospitals to discuss this issue with admitted patients who are 18 years or older. Kentucky law also recognizes your right to make choices about your medical care. You have the right to request or refuse treatment and to ask that treatment be discontinued. You also have the right to make an advance directive.
Advance Directive
An advance directive is a legal, written provision made by an individual concerning decisions that may come up about his or her health care in the future—such as the use of life support machines and life prolonging medical treatment. An advance directive can also be used to appoint someone to make health care decisions for you if you should ever become unable to make your own decisions. Three types of advance directives can be used in Kentucky: Advance directives for mental health treatment, durable powers of attorney, and living will directives.
Advance Directive for Mental Health Treatment
This document allows an adult to make his wishes known regarding certain mental health treatments. It also allows that person to appoint someone else (a surrogate) to make sure the provisions of the document are carried out. Covered in an advance directive for mental health treatment are: refusal of specific psychotropic medications, refusal of electric shock therapy, stating preferences for psychotropic medications, and procedures for emergency interventions.
Living Will
This document enables adults to make their wishes known in writing regarding which medical treatments they do and do not want, before there is a medical emergency, the onset of a permanent unconscious state or a terminal condition. A terminal condition is a condition which cannot be cured, cannot be reversed and which will cause death in a short period of time. Anyone 18 years of age or older and of sound mind can sign a living will directive. This document is only in effect when the individual can no longer make decisions for him/herself and is found to be in a terminal condition. This document also allows patients to choose another adult to speak for them concerning medical treatment when they can no longer speak for themselves. Subject to certain exceptions in the laws, the surrogate would have the power to authorize the withholding or withdrawal of life prolonging treatment. The surrogate may be anyone 18 years of age or older, of sound mind and able to make a decision. The designee cannot be an employee of a hospital unless he/ she is a relative of the individual.
Medical Power of Attorney
This document allows individuals to designate another adult to make health care decisions for them when they are no longer able to decide for themselves. This document can also include personal and financial decisions. Please note that if a power of attorney document does not specifically contain the language that allows the designee to make healthcare decisions, the designee may not do so.
Our Practice
- Jennie Stuart Health will make each individual’s advance directive a part of his or her medical record when the completed document is received. The individual must discuss the advance directive with his/ her physician. If a physician morally, religiously, or professionally cannot honor an individual’s advance directive decision, Jennie Stuart Health staff and the physician will not impede the transfer of the patient to another physician/facility that can meet the patient’s request.
- A living will only becomes valid in the event you are near end of life, permanently unconscious, or are unable to communicate or make your own decisions. Until then, you will be asked to make health care decisions for yourself. If your living will states you want no extraordinary life support measures, you will still be provided routine care and pain control.
- The contents of a living will are not permanently binding. A living will can be invalidated by shredding the document. A new living will can then be executed.
- Your hospital or other health care providers must see your original living will or advance directive every time you are admitted for care even though you do not need to execute a new document. This action helps us make sure we have your most updated directive.
- Just provide the original document on admission and ask that a copy be made for your medical record, be sure the original is returned to you.
Special Considerations
Surgical Procedures:
It is the general practice of the Surgery and Anesthesia Departments to
institute life-saving measures in the surgical suite. Therefore, the application of
the Advanced Directives Policy will generally not apply in this setting.
Outpatient Areas of Jennie Stuart Health:
We do not automatically honor advance directives in outpatient areas as we do
not know the wishes of the patients or the visit may be for unrelated care. If
patients would like their wishes honored in these areas, we request the patient
to speak with their physician prior to the outpatient treatment. If applicable,
the physician will order the patient’s wishes related to resuscitation for each
visit. Such outpatient areas include the Wound Healing Center, Outpatient
Procedures, Outpatient Radiology and Laboratory Services, Cardiac and
Pulmonary Rehabilitation, Rehabilitation & Sports Medicine, Occupational
Health, and Convenient Care.
Emergency Department (ED):
If you are brought into the ED for care, please bring a copy of your advance
directive. The ED will honor your advance directive if:
- After immediate stabilization, two physicians determine that the immediate medical condition is indeed terminal, and
- Your current advance directive document is presented to the staff.
Emergency Medical Transportation Services:
JSH does not own or operate an ambulance or medical transportation
service. Emergency and non-emergency medical transportation are provided
by various Emergency Medical Services (EMS) agencies. Kentucky law
forbids EMS from recognizing any DNR request unless it is specifically spelled
out on the "Kentucky Emergency Medical Services Do Not Resuscitate
(DNR) Order."
This EMS DNR order applies only to resuscitation attempts by health care providers in the prehospital setting (i.e., certified EMT-First Responders, Emergency Medical Technicians, and Paramedics)--- in patients’ homes, in a long-term care facility, during transport to or from a health care facility, or in other areas outside acute care hospitals.
If you do not wish EMS to resuscitate you, please fill out the Kentucky State DNR form according to the supplied instructions. This form is available for download at http://manuals.sp.chfs.ky.gov/Resources/Pages/ formsBrowser.aspx
Without this form, EMS will do everything within their power to keep you alive. Keep in mind that this form is only applicable if you stop breathing or your heart stops beating.
It is also important to note that you must present EMS with the original signed document, not a copy. We suggest that you make several originals so all concerned parties will have an actionable form.
Without an Advance Directive
You will not be required to make an advance directive as a condition for receiving health care by any physician, health care facility, or other health care provider. Jennie Stuart Health will not discriminate against any patient based on the presence or absence of an advance directive.
Exceptions to Your Directive
Please understand that, in some cases, having an advance directive will not mean that life-sustaining machines and other treatments will not be used. Remember that your directive takes effect only when you are terminally ill or permanently unconscious and no longer able to make decisions for yourself. Living Will Directives are not effective for those patients who are pregnant. Pregnant patients who have designated a surrogate will receive treatment unless the attending doctor and one other doctor document that providing treatment will not allow the baby to be developed or born alive, or that the patient will suffer prolonged pain or harm as a result of the treatment and nourishment.
Organ, Tissue and Eye Donation
Organ, tissue and eye transplants offer patients a new chance at healthy, productive and normal lives and return to their family, friends and communities. At the time of death, patients have the opportunity to give that second chance at life through the gift of organ, tissue and eye donation. Many states, including Kentucky, allow individuals to make the decision to donate life through a confidential electronic donor registry. This registry ensures that those who want to donate are able to do so. Joining the donor registry is often done at the driver’s license office when a driver’s license is renewed. The staff will ask if you want to join the registry. You can also join the registry online at www.donatelifeky. org. You can also indicate your desire to be an organ donor on a Living Will or donor card. However, these documents may not be available when they are needed by the appropriate staff. Everyone is encouraged to make the decision to donate on the Donor Registry and to let your family know of your decision. Your commitment to donate will not interfere with your medical care. Donation becomes an option only after all lifesaving efforts have been made. You will receive the best possible care whether or not you have chosen to be a donor. There is no cost to your family or estate for donation. Donation will not delay or change funeral arrangements. An open casket funeral is possible. You can give hope to the thousands of men, women and children that are waiting for a second chance at life. By becoming a donor at the time of death, one person can potentially save up to eight lives through organ donation and heal more than fifty others through tissue and cornea donation. You have the power to save lives their lives.