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 21