1. ADVANCE DIRECTIVES Presented by Barbara Wojciak, Chaplain St. Vincent’s Birmingham Pastoral Care

4. Background Explosion of medical technology Just because something CAN be done medically doesn’t always mean it SHOULD be done. Benefit vs. burden

5. Facing the reality of death with the confidence of faith “We have a duty to preserve our life and to use it for the glory of God, but the duty to preserve life is not absolute, for we may reject life-prolonging procedures that are insufficiently beneficial or excessively burdensome.” Ethical and Religious Directives for Catholic Health Care Services Part Five, Issues in Care for the Dying

6. Patient Self-determination Act, 1990 Congress passed a law requiring healthcare providers to notify all adult patients of their RIGHT to make decisions regarding their medical care. Patients have the legal right to ACCEPT or REFUSE treatment.

7. Patient Self-determination Act, 1990 Under ordinary circumstances, patients are able to speak for themselves. Advance directives were developed to address those circumstances where patients are UNABLE to speak for themselves or make competent decisions regarding their care.

8. Patient Self-determination Act, 1990 Legislation was developed to maintain the DIGNITY of each person and safeguard their RIGHT to make choices about end-of-life issues. Puts a human face on healthcare: task of medicine is to CARE even when it cannot CURE.

9. Definition: Advance Directive Document written in advance of serious illness that states your choices for healthcare Do not need a lawyer (forms available at any hospital) Do not need to be notarized Can be changed at any time

10. Definition: Advance Directive Should be shared with doctor, family, those who might be involved in making healthcare decisions for you ONLY used when you CANNOT SPEAK FOR YOURSELF Takes effect when 2 doctors agree that your condition is terminal, not curable, and death is approaching

11. Definition: Advance Directive Addresses procedures that could prolong the dying process Does not mean that you will not be treated; quality care will still be offered. Advance directives simply give guidance as to what AGGRESSIVE measures will or will not be offered.

12. Myths Forgoing life support is suicide. Illness is cause of death, not unnatural intervention Intent is not to bring about death Legal right to terminate

13. Myths Once treatment is begun, you must continue Legal right to terminate covers all phases of treatment. Stopping artificial fluids and nutrition is same as starvation Needs of body in dying process Stopping fluids, tube feeding is no more starving than removing ventilator is strangling

14. Terminating life support requires court order -Again, everyone has legal right to terminate. Major religions frown on advance directives. -Not so; seen as means of preserving dignity of human life. Advance directives are not legal unless they are on the official state form -May be written on the back of an envelope. -Official form may enhance compliance by healthcare system. -Guards against vague language Myths

15. Signing an advance directive means that I will receive no treatment. Palliative care vs. curative care Goal is now comfort rather than cure My insurance company will not pay for treatment the doctor prescribes if I have an advance directive that asks for palliative care at life’s end. Goal of care: comfort, whatever it takes Ex. Radiation treatment to relieve cancer pain Myths

16. Two types of advance directives: (1)Living Will (2) Durable power of attorney for healthcare or Healthcare Proxy

17. Living Will Written document that states what types of treatments you would want or not want if you become terminally ill and unable to indicate your wishes.

18. Living Will Examples of treatments/procedures named in living will:  DNR orders (not being resuscitated or revived if heart or breathing stops)  Being connected to or disconnected from machines that keep patient alive  Time-limited trials  Having feeding tube inserted  Undergoing dialysis

19. Core issue: Quality of life Make clear to doctor and family what level of survival would be acceptable to you. Treatment will be offered accordingly: aggressive or palliative care

20. Durable Power of Attorney for Healthcare or Healthcare Proxy Written document in which you name a person or persons to make healthcare decisions for you IF you are UNABLE TO SPEAK FOR YOURSELF.

21. Durable Power of Attorney for Healthcare or Healthcare Proxy You can give this person the right to make all decisions s/he feels are necessary, based on how well they know you, OR S/he can be instructed to use only the list that you have developed

22. Anna’s Story Who suffered more in this story? Anna or her granddaughter? What could have made this easier?