Advanced Directives Policy
PENNSYLVANIA ADVANCE HEALTH CARE DIRECTIVE
You have the right to decide the type of health care you want. Should you become unable to understand, make or communicate decisions about medical care, your wishes for medical treatment are most likely to be followed if you express those wishes in advance by: (1) naming a health care agent to decide treatment for you; and (2) giving health care treatment instructions to your health care agent or health care provider.
An advance health care directive is a written set of instructions expressing your wishes for medical treatment. It may contain a health care power of attorney, where you name a person called a "health care agent" to decide treatment for you, and a living will, where you tell your health care agent and health care providers your choices regarding the initiation, continuation, withholding or withdrawal of life-sustaining treatment and other specific directions.
You may limit your health care agent's involvement in deciding your medical treatment so that your health care agent will speak for you only when you are unable to speak for yourself or you may give your health care agent the power to speak for you immediately. This combined form gives your health care agent the power to speak for you only when you are unable to speak for yourself. A living will cannot be followed unless your attending physician determines that you lack the ability to understand, make or communicate health care decisions for yourself and you are either permanently unconscious or you have an end-stage medical condition, which is a condition that will result in death despite the introduction or continuation of medical treatment. You, and not your health care agent, remain responsible for the cost of your medical care. If you do not write down your wishes about your health care in advance, and if later you become unable to understand, make or communicate these decisions, those wishes may not be honored because they may remain unknown to others. A health care provider who refuses to honor your wishes about health care must tell you of his or her refusal and help to transfer you to a health care provider who will honor your wishes.
Please see below for Advanced Center for Surgery’s Advanced Directive Policy:
SUBJECT: ADVANCE DIRECTIVES
PURPOSE:
To provide the health care team members information to assist them in working with patients
who have Advance Directives such as a living will, healthcare surrogate or proxy appointment, or durable power of attorney.
POLICY:
In an ambulatory care setting, where we expect to provide less invasive care to patients who are not acutely ill, admission to the center indicates the patient will tolerate the procedure in the ambulatory setting without difficulty. If a patient should suffer cardiac or respiratory arrest or any life-threatening condition, the patient will be transferred to a more acute level of care, that is, the hospital emergency room.
Advance directives include written or verbal directions a patient gives in advance to state choices for health care or name someone to make those choices for the patient if the patient is unable to make decisions for himself/herself. A living will states what kind of medical treatments would be acceptable at the end of life.
If a patient, who is to receive a procedure at the Center, presents the staff with a living will, the patient must be advised that the Center will not honor any living will that does not allow resuscitation. It is the policy of the Center to transfer any patient requiring resuscitation or emergency care to the hospital. The hospital can determine when to implement the living will.
A patient may have a person designated as an agent, proxy, or health care surrogate or may have granted a person a durable power of attorney for health care. This enables the person to perform as a decision maker in the event the patient cannot speak for himself/herself. The scope of the decisions this other person may make for the patient may be defined in a document. The Center will record whether such a document has been presented to the Center. The document will be placed in the medical record along with a living will, if one was also presented to the Center for inclusion in the Center’s records. When a patient has designated someone to speak in his/her behalf when the patient cannot speak for himself/herself, that person should be contacted to advise of any pending transfer to a higher level of care. That person may express a choice of the hospital to contact for a transfer. If possible, considering the physician’s privileges and close proximity of the facilities, the health care surrogate’s choice should be honored. The designated person may also receive information from the physician and be asked to make decisions should the patient be unable to participate in the decision.
It is required by regulation that the provider or facility notifies a patient if it will not honor an advance directive. The patient has a right to select another provider or facility.
Patients who disagree with this policy must address the issue with the attending physician prior to signing the form acknowledging an understanding of the policy regarding advance directives and living wills.
Patients must be informed of the policy prior to the date of admission so that the patient will have the opportunity to discuss any concerns with the attending physician and/or make arrangements for a change in admission. The patient must also receive information about where he/she can learn information about a advance directives if the patient desires to consider preparing or revising one. The Center must provide information about advance directives should the patient request this information. Information may include a state provided resource directory for advance directives such as a state agency, library, or state web site or sample forms provided by state agencies.
It is not required that a patient have a living will or advance directives. It is required that the Center inform the patient of the right to have an advance directive, the right to have the advance directive placed in the patient’s medical record, the policy of the Center to resuscitate and transfer when indicated, and the right to discuss these policies with the provider of services.
