Advance directives help make your wishes known

Life is not always as we would have it. Problems occur, often without warning. Our health or that of a loved one may change suddenly or slowly over time.

If a health problem should become serious, would you know what kind of health care or treatment to choose? Is there someone who would know what you would want if you couldn’t speak for yourself? Choosing medical treatments requires careful, open communication with your family, physician, and others who have your best interests at heart. Responsible patients should consider these issues in advance and discuss them with loved ones.

Advance directives enable you to specify treatment choices and to name a person to make health care decisions for you if you are unable to do so. You are encouraged to speak with your physician about choices available to you. Here are some of the questions that you may wish to consider:

  • What rights and responsibilities do I and my family have in making choices about my treatment?
  • Do I have enough information to make these choices?
  • If I am unable to make decisions for myself, who would decide for me — my family, physician, clergy, or attorney?
  • What if my heart stops? Should resuscitation procedures be done? Would this answer be different if a chronic, debilitating, terminal illness was involved?
  • Will an undue financial burden be placed on me or my family as a result of a particular health care decision, especially if the outcome is uncertain?
  • If the illness is terminal, at what point would I want to stop treatment and accept palliative care? Should life-prolonging treatment continue at that point?
  • Have I or my family made my wishes known? Have I discussed these important questions with my physician and family?
  • If hospitalized, have I or my family discussed what kind of care I need when I leave? Do I have a discharge plan that meets my needs?

There are several different types of advance directives

A legal document that enables you to specify treatment decisions and to appoint someone to make health care decisions for you if or when you become unable to make such decisions for yourself. (An attorney is not required.) You can obtain a Health Care Proxy form online at http://www.health.ny.gov/forms/doh-1430.pdf or contact the Phelps Case Management Department at 914-366-3340. If you should need hospitalization, please bring a copy of your Health Care Proxy with you to the hospital each time you come.

A written physician order that is mutually agreed upon by the patient and physician, not to initiate CPR. If the patient does not have capacity, the person named in his/her Health Care Proxy and his/her physician must mutually agree whether or not to initiate CPR. (A DNR does not mean withholding other types of care or compromising the quality of care).

A signed statement indicating your views and specific wishes concerning life sustaining medical care, should you become terminally ill, incapacitated or unable to communicate or make decisions.

Medical Orders for Life Sustaining Treatment, MOLST is a directive that serves as a New York State living will. It allows physicians to document end-of-life information and orders regarding resuscitation, intubation, mechanical ventilation, nutrition, feeding tubes, hydration, antibiotic administration and any other patient-specific advance directives. Ask your doctor or nurse if you would like more information about MOLST.

Durable Power of Attorney for healthcare
A legal document that names your healthcare proxy.

Durable Power of Attorney for finances
A legal document with which you empower another person to manage your financial affairs when you cannot. It is separate from the power of attorney for healthcare. You can choose the same person for both your healthcare and financial POAs or different people to represent you.

The Family Health Care Decisions Act (FHCDA), signed into New York State law in 2012, allows family members to make healthcare decisions on behalf of patients who have not prepared advance directives and who have lost their ability to make such decisions. These decisions include the withholding or withdrawal of life-sustaining treatment. Potential surrogates are appointed in order of priority (guardian, spouse or domestic partner, adult son or daughter, parent, adult brother or sister, close friend or relative). In addition to ensuring that family members or close friends can make decisions for patients who lack capacity and have no proxy agent, the law also provides for patients who have no available next of kin (surrogate). In such cases, the treating physician is authorized to make decisions for the patient. This law applies only to patients in hospitals or nursing homes.

Glossary of terms

Artificial Nutrition and Hydration: Delivering food and fluids to the body by means other than by mouth.

Cardiac Arrest: A sudden stopping of heartbeat.

Cardiopulmonary Resuscitation (CPR): Artificial respiration and heart massage to restart the heart and lungs.

Emergency Code: The summoning of a special medical team to start CPR and other life support measures when a patient has gone into cardiac or respiratory arrest.

Extubation: Withdrawal of mechanical breathing tubes.

Informed Consent: Permission given to receive tests, treatments or procedures after you have been fully informed of their potential benefits and/or risks.

Intubation: Insertion of a tube, most commonly into the air passages, to provide mechanical breathing for a patient.

Life Support Systems: Any intervention or combination of interventions used to maintain body functions when they are not likely to function on their own.

Respirator/Ventilator: Types of mechanical devices used to provide assisted breathing for patients with respiratory failure.

Phelps Hospital has an Ethics Committee, composed of a variety of health care professionals and other concerned individuals. The Committee provides a forum for further discussion of these issues. Patients and their families, physicians, nurses and staff members can request an Ethics Committee Consultation. To arrange for a consultation, contact the Medical Staff Office at 914-366-3360.