ADVANCE CARE PLANNING
It can be difficult for doctors and loved ones to know what kind of treatment you want if you are unable to tell them . The best way to make sure your wishes are respected is to discuss them with your health care provider and your loved ones while you ’ re healthy and then fill out an advance directive .
WHAT IS AN ADVANCE DIRECTIVE ?
An advance directive , as implied by the name , gives instructions in advance regarding what type of care you want or do not want in the event you lose the ability to speak for yourself . Most advance directives also designate who you would prefer to help make sure your instructions are followed . The UAB Health System has both inpatient and outpatient facilities where you can receive information about advance directives . Federal law requires that all patients admitted to a hospital are asked if they have an advance directive , and if not , to supply them with that information if requested . Every patient admitted is asked about advance directives regardless of health condition .
RESOURCES
While most advance directives refer to medical care , Alabama does recognize psychiatric ( sometimes called “ behavioral ”) advance directives . If you have such a directive or would like information about this type of directive , please talk to your treatment team .
There are generally two types of medical advance directives : a living will and a durable power of attorney for health care decisions :
• Living will : A written declaration of your wishes for medical care desired at the end of your life , specifying choices about what treatment you would or would not want . Many living wills , including the Alabama Advance Directive for Health Care , include appointing a health care proxy to make sure your instructions are followed .
• Durable power of attorney for health care decisions : Most durable power of attorney documents do not include specific instructions for your end-of-life wishes ; rather , the document allows you to appoint someone to speak on your behalf . It is important to choose someone who knows you well and can represent your morals and values .
WHEN DOES AN ADVANCE DIRECTIVE GO INTO EFFECT ?
An advance directive becomes active when you are too sick to speak for yourself and meet either of these two conditions :
• Terminally ill or injured : Two doctors have determined that you have a condition that cannot be cured and that you will likely die in the near future from this condition .
• Permanent unconsciousness : Two doctors have determined that you have a condition that results in the inability to think , feel anything , knowingly move , or be aware of being alive . The doctors believe this condition will last indefinitely without hope for improvement .
WHAT KINDS OF CHOICES NEED TO BE MADE ?
Advance directives define whether or not you would want life-sustaining treatment if you were terminally ill or injured or in a state of permanent unconsciousness . Life-sustaining treatment means drugs , machines , and / or medical procedures that may keep you alive but will not cure you . You are also asked about whether you would want artificial nutrition or hydration provided through a tube or IV to keep you alive if you can no longer eat , either on your own or with someone helping you . Advance directives are also used to appoint a health care proxy ; however , you are not required to appoint a proxy .
WHO CAN HELP ME COMPLETE AN ADVANCE DIRECTIVE ?
It is normal to feel anxious and uneasy about making these choices , but the goal is for you to remain in control even if you become too sick to speak for yourself . Choose someone you trust to discuss what you want or don ’ t want at end of life . Your doctor , nurse , hospital chaplain , and medical social worker are available to assist you . Hospital chaplains or patient advocates are available to witness or notarize these documents .
FREQUENTLY ASKED QUESTIONS
• Am I required to have an advance directive ? No . The UAB Health System is committed to providing the best care for every patient , regardless of what choices have been made about life-sustaining treatments at the end of life .
• I have an advance directive from another state . Will it be honored ? Generally speaking , yes , but since there are differences from state to state , completing an advance directive using Alabama ’ s form can help remove uncertainty . Please provide your treatment team with a copy for review .
• Will my advance directive be honored during surgery ? Yes . However , many interventions that might be considered life-sustaining treatment in other settings are a routine part of anesthesia and surgery . If you are undergoing surgery , it is important that you discuss your advance directive with your surgeon and anesthesiologist prior to surgery , so they can discuss with you the best way to provide your care .
• Are there conditions when my advance directive will not be honored ? –. Under Alabama law , advance directives cannot be honored during pregnancy . –. Advance directives are not routinely honored in the outpatient setting ; please discuss your preferences with your treatment team .
• Do I have to choose someone from my family as my proxy ? No . You may pick whoever you feel would represent you best . That may be someone from your family but also could be a good friend , same-sex domestic partner , church member , or neighbor . The point is that YOU choose who can speak for you if you cannot .
• What should I do with my advance directive ? Copies should be given to your health care provider , your health care proxy , and to your family . uabmedicine . org 19