When you need medical care, you have the right to make choices about that care. But there may come a time
when you are so sick that you can't make your choices known. You can stay in charge by putting your choices in
writing ahead of time. This is called giving an advance directive.
Any spoken or written decision or instruction about the health care you want in the future is called an advance
directive. You can tell your doctor or family what you want. But it's best to write it down.
Advance directives also are sometimes called living wills and durable health care powers of attorney. If you have
already signed one, be sure your doctor, your hospital and your family have a copy. If you have not signed a form,
you may use the Maine Hospital Association's
health care advance directive form. But you don't have
to use this form.
Anyone living in Maine who is 18 years of age or older can complete an advance directive. If you are younger than
18 you may also be able to complete an advance directive under certain, limited circumstances.
If you sign an advance directive, your family and your doctor will know who to talk to about your care or what
kinds of treatment you want or don't want when you are too sick to decide. This could happen if you have a serious
illness or are near the end of life. If doctors don't know your wishes, they will treat you until they can ask your
family what you want. If your family doesn't know, you may get treatments you don't want or which you would stop
if you had your way. In an emergency you will receive care until the doctors can determine your condition and what
your wishes are.
The Maine Hospital Association form allows you to do make a number of choices,
including:
- Choose someone to make all your health care decisions beginning either right away or when you are too sick
to decide. That person is called your agent. Your agent can be a family member or friend. If you choose
an agent, two (2) witnesses must sign your advance directive.
- Choose whether or not you want certain treatments when you are very ill or may not live. For example, you
can choose what you wish to have done if you are dying or if you are in a permanent coma. Your agent must follow
any choices you make in an advance directive.
- State a desire to donate your organs. (Your family will make the final decision, but this will tell
them your wishes.)
- Name your primary doctor
Facts about
Health Care Advance Directives gives you specific advice about each part of the form.
If your heart or breathing suddenly stop in the hospital, drugs, machines and other means will be used to try
to restart them. This is called cardiopulmonary resuscitation or CPR. CPR is always done unless your doctor writes
an order called a "Do Not Resuscitate" order or DNR. If you have concerns about CPR, discuss them with
your doctor while you are well. If you make an advance directive that says you do not want CPR, it may not be possible
for the hospital to follow your decision all the time. For example, if you come to the emergency room and your heart
has stopped, there may be no time to check your advance directive before CPR is started. If you do not want CPR, your
doctor must write a DNR order for you and put it in your hospital record. Your doctor will then give you a special
orange bracelet designed to alert ambulance crews and hospital emergency personnel that you do not want CPR.
Unless you state something different, your advance directive will be used only when you are too sick to choose your
care or tell others what care you want. Your doctor will help decide if and when that time has come and when your
advance directive should be used.
If you do not name an agent or do not have an advance directive, the doctor will ask your family what treatment you
would want, in this order:
- Spouse (unless legally separated) or similar relationship
- Adult children
- Parents
- Adult brothers and sisters
- Adult grandchildren
- Adult nieces and nephews
- Adult aunts and uncles
If there are family members whom you do not want to make decisions for you, you need to put this in
writing and give it to your doctor or hospital.
Your family can tell your doctor to continue to treat you. They can also tell your doctor to stop or not give
treatment to keep you alive (life sustaining treatment) if you are dying or in a permanent coma. Family members may
not, however, be able to make other decisions for you unless you name one of them as your agent in your advance
directive.
If the doctor can't reach a family member, the doctor may ask another adult relative or good friend who knows your
values.
Yes. If your doctor, hospital, or other place of health care has any special rules about health care decisions,
or if they will not carry out your decisions, they must tell you. They must then arrange to move you to a doctor,
hospital, or other place which will carry out your decisions.
You may also choose to sign a different form, called a mental health directive, that allows you to choose what
treatment you want if you become very mentally ill and are unable to make health care decisions.
Learn more about Advance Directives for Planning Mental
Health Care
When you need medical care, you have certain rights, including the right to refuse care. You have a right to
know:
- what your medical problem is and what tests and treatments may be needed
- what the doctor thinks can be done and what the usual risks may be
- if there are other ways to care for you
- what may happen if you refuse care
Every hospital and many other places that provide health care in Maine have advance directive forms or can tell you how to
get them. Just ask your doctor or nurse. They can explain the forms, but they cannot give you legal advice.
No one can make you sign a form or stop you from signing it. You also have the right to change or cancel a form
at any time. The advance health care directive form does not allow others to control your money or property. It does
not allow anyone to violate laws against mercy killing and euthanasia.
If you have a complaint about how a hospital or medical provider handled your advance directive, go to
the last page of Facts
about
Health Care Advance Directives for contact information.
Your doctor will put the advance directive in your medical record, where it should be seen by everyone involved in your care. Later
on,
if you are dying or in a persistent vegetative state, the doctor caring for you will follow the directions in your advance directive.
If the
doctor is not willing to follow your directions because of the doctor's own personal or religious beliefs, he or she must transfer you
to the care of another doctor who will follow your directions.
Sometimes people who have signed advance directive are surprised and upset when emergency medical personnel disregard a portion of the
advance directive and
administer life-support anyway. The reason that this may happen is that, in an emergency, the staff may not have time to read the
advance directive,
to make sure that the patient is in a terminal condition and that it is indeed appropriate to withdraw treatment. If you are already
in a
terminal condition and feel strongly that you do not want to be given life-support under any circumstances, you should talk to your
doctor.
Your doctor may be able to notify the ambulance service and the emergency room that they should not give life-support and that they
should
only give you treatment that will ease your pain and keep you comfortable.
It is possible that you may get sick, injured, or have to go to a hospital while visiting in another state. You should carry a copy
of your advance directive with you in your wallet or purse, since your medical record will not be available right away to the doctors there.
You should also have your advance directive witnessed by a notary public or attorney if you travel sometimes and are concerned about how your
advance directive will be treated in another state. Whether the doctors there follow your directions depends on whether that state has an
advance directive law similar to Maine's. As of June 1992, at least 41 states recognized advance directive.
The law provides that insurance companies may not base anything in an existing or future life insurance policy on whether a
person does
or does not have an advance directive.
You can plan in advance for the time when you may not be able to state your health care choices. Talk with your doctor,
family members, clergy, and others about your wishes. Put your decisions in writing. This may save your family and others from having
to make painful decisions later on.
You can use the Maine Hospital Association form and instructions. You don't have to have a lawyer,
although you may want to speak with one. If you would like free assistance from a Legal Services for the Elderly attorney,
please call the Holeline at 1-800-750-5353 (623-1797 from Augusta). After you sign the form, put the original in a safe place and be sure to give copies to your
family, your doctor, and your hospital. You will have earned their thanks and your own peace of mind.
September 2008
