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Advance Directives

Advance directives are normally one or more documents that pertain to treatment preferences and the designation of a surrogate decision-maker in the event that a person should become unable to make medical decisions on their own behalf. They are in the form of a living will, life-prolonging procedures declaration, designation of a heath care representative or proxy, and durable power-of-attorney. Your advance directives will not take away your right to decide your current health care. Your advance directive will only be used when you are unable to communicate or when your physician decides that you no longer have the mental competence to make your own choices.

Federal Law

The 1990 Patient Self-Determination Act (PSDA) encourages all patients to make choices and decisions now about the types and extent of medical care they want to accept or refuse should they become unable to make those decisions due to illness. The advance directive document is a way for you to communicate what kinds of medical care and treatment you do or do not want if you become unable to make these decisions for yourself.

Indiana Law

Under Indiana law, a written advance directive can communicate a competent person’s wishes regarding health care, including life-prolonging treatment. The directive can designate a person who will have the role of making difficult health care decisions for you, if you become unable to state your wishes. A formal advance directive can be in the form of a living will, a life-prolonging procedures declaration, an appointment of a health care representative, or an appointment of a power –of-attorney for health care (Indiana Code IC16-8-11). You have a right to make an advance directive if you want to, but you are not required to do so.

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. The Indiana Living Will Act is found at Indiana Code § 16-36-4.

Life-Prolonging Procedures Declaration

This document is the opposite of a living will. You can use this document if you want all life-prolonging medical treatments used to extend your life. This declaration must be signed and dated and witnessed by two people who are at least 18 years old and who know you well but are not related to you. These witnesses should not be your potential heirs or your health care providers, and they should not hold direct financial responsibility for your health care.

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. To choose a health care representative, you must fill out an appointment of health care representative document that names the person you choose to act for you. 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.

Power of Attorney for Health Care

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 to make your health care decisions for you if you become unable to make your own health care decisions. This type of advance directive relates to any medical situation, not just terminal illness.

River View Surgery Center Advanced Directives

The patients at River View Surgery Center will be asked if they have an advance directive during the pre- operative assessment interview. If they brought a copy, it will be attached to their medical record. If they do not have an advance directive; there will be no further activity. The River View Surgery Center will acknowledge the presence of an advance directive if it is present on the chart. The River View Surgery Center is an Ambulatory Surgery Center whose patients are expected to be at low risk for surgical and/or diagnostic procedures. All patients have been instructed they should be accompanied by an individual who will assure they will have assistance to return to their home following the procedure. In the event of an unexpected adverse incident during surgery, the person who accompanied the patient would be asked to contact any person who may legally make decisions regarding patient care. Without an advance directive which prohibits cardio-pulmonary resuscitation, all patients who experience cardio-pulmonary arrest will be resuscitated.

For More Information

For additional information, including sample advance directive forms, can be found online at the following websites:

» www.in.gov - advance directives (.pdf file)
» www.iahhc.org - living will (.pdf file)
» www.iahhc.org - life prolonging procedures declaration (.pdf file)

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