All patients have the right to decide which treatments they will accept and which they will refuse. Once your doctor has explained your options, you can put your wishes in writing with an advance directive. Our staff will follow your directive to ensure your wishes are carried out, so your family doesn’t need to make difficult medical choices on your behalf.
What is an Advance Directive?
Advance Directives are documents written in advance of the time when you are unable to make healthcare decisions for yourself. You have a right to make important legal decisions related to your care, and we can help you through this important process.
Your care will not be limited if you don’t have an advance directive. If you do have an advance directive, our employees and the doctors who work within our system will follow your directions in accordance with the law.
Types of Advance Directives
Directive to Physicians and Family or Surrogates (Living Will)
A “living will” allows you to make important decisions ahead of time about the type of care you want to receive. This may include instructing your physician not to use artificial methods to prolong the process of dying if you become terminally ill.
If you sign a directive, ask your physician to make it part of your medical record. If you are unable to sign a written directive, you can issue a directive verbally, or by other means of non-written communication, in the presence of your physician.
If you have not issued a directive and become unable to communicate after being diagnosed with a terminal or irreversible condition, your attending physician and legal guardian, or certain family members in the absence of a legal guardian, can make your decisions concerning withdrawing, withholding or providing life-sustaining treatment. Your attending physician and another physician not involved in your care can also make decisions to withdraw or withhold life-sustaining treatment if you do not have a legal guardian and certain family members are not available.
A directive becomes effective only after you have been diagnosed with a terminal or irreversible condition.
Medical Power of Attorney (POA)
A Medical Power of Attorney allows you to designate someone you trust — an agent — to make healthcare decisions on your behalf should you become unable to make these decisions yourself.
The person you designate must be an adult. You may choose a family member — such as your spouse, child, brother or sister — or a close friend. If you select your spouse and then become divorced, the appointment of your spouse as your agent is revoked.
The following people cannot be appointed as your agent:
- Your treating healthcare provider
- An employee of your healthcare provider, unless he or she is related to you
- Your residential care provider or an employee of your residential care provider, unless he or she is related to you.
The person you designate has authority to make healthcare decisions on your behalf only when your attending physician certifies that you lack the capacity to make your own healthcare decisions. Your agent cannot make a healthcare decision if you object, regardless of whether you have the capacity to make the healthcare decision yourself, or whether a Medical Power of Attorney is in effect.
Your agent must make healthcare decisions after consulting with your attending physician, and according to the agent’s knowledge of your wishes, including your religious and moral beliefs. These decisions can include authorizing, refusing or withdrawing treatment, even if it means that you will die. If your wishes are unknown, your agent must make a decision based on what he/she believes is in your best interest.
Out-of-Hospital Do-Not-Resuscitate (DNR)
An Out-of-Hospital DNR order allows you to refuse certain life-sustaining treatments in any setting outside of a hospital. These settings can include home health, hospice, nursing homes, ambulances, and hospital emergency rooms. This Advance Directive must be issued in conjunction with your attending physician and signed by two witnesses on an orange sheet of paper.
Declaration for Mental Health Treatment (DMHT)
A Declaration for Mental Health Treatment allows you to tell healthcare providers your choices for mental health treatment, in the event that you become incapacitated. It applies to mental hospital treatment only.
Unlike the living will and medical power of attorney, which do not expire, the DMHT expires 3 years from the date that you sign it. If you are incapacitated on that date, the document continues in effect until you are again able to make your own decisions.
Additional Information on Advance Directives
If you become unable to make your own healthcare decisions and do not have a legal guardian or someone designated under a Medical Power of Attorney, then certain family members and others can make medical treatment decisions on your behalf.
Legal Aspects of Advance Directives
An advance directive does not need to be notarized. Neither this hospital nor your physician may require you to execute an advance directive as a condition for admittance or receiving treatment in this or any other hospital. The fact that you have executed an advance directive will not affect any insurance coverage that you may have.
Patients and families may participate in ethical questions that arise in the course of care, including issues of conflict resolution. Coral Gables Hospital has a formal process in place to address ethical issues and dilemmas in your care. Should you or your family desire an ethics consultation, please ask your nurse to contact the Hospital Ethics Consultation Team.