Instructions for Completing Your Advance Directive

An Advance Directive for Health Care is a document used to communicate your health care decisions if/when you become unable to communicate them directly. This document will allow your loved ones and medical providers to know your preferences and will ease their burden when faced with making difficult health care decisions on your behalf. By completing an Advance Directive for Health Care, you give your loved ones the piece of mind of knowing that your wishes are being honored. You must be at least 18 years old and of sound mind to complete a valid Advance Directive for Health Care.

Oklahoma law presumes you always want to be resuscitated if your heart stops or if you stop breathing. It is also presumed you always want to receive tube feeding when you can no longer take food by mouth. Depending on your medical condition and prospects for recovery, these presumptions may not reflect your wishes. The Advance Directive for Health Care is your opportunity to affirmatively state your desires and overcome these presumptions.

The Advance Directive for Health Care form has three parts: (1) Living Will; (2) Appointment of Health Care Proxy; and (3) Anatomical Gifts

As you complete this form, remember (1) this document only comes into play if you are unable to express your desires directly; and (2) that there is no right answer other than the answer that is right for you.

Part I: Living Will

This section is where you express your desires for treatment if you develop a terminal condition, become persistently unconscious or suffer from an end-stage condition. The form presents you with three scenarios and allows you to express your wishes for treatment under each scenario. The following definitions will assist you to complete this form.

A Terminal Condition is caused by an illness or injury that is incurable and cannot be reversed. In order to be considered terminal, two physicians must agree that, even with medical treatment, death will likely occur within six months.

A Persistently Unconscious State or Persistent Vegetative State (PVS) is a deep and permanent unconsciousness. Patients in this condition may have open eyes, but they have very little brain activity and are capable only of involuntary and reflexive movements. Confirming a diagnosis of PVS requires many tests that may take several months to complete. Unlike patients with other types of coma-like conditions, patients in PVS will never “wake up” or regain health. Patient in PVS cannot feel hunger, thirst or pain.

An End-Stage Condition is a condition caused by injury, disease or illness that results in a gradual and irreversible loss of mental and physical abilities. A person with an end-stage condition may be unable to speak or walk, may be unable to control bowel and bladder functions, may have decreased appetite and difficulty swallowing and eating, and may not recognize loved ones. Examples of end-stage conditions include dementia caused by Alzheimer’s disease or severe stroke. Medical treatments of these conditions will not improve the patient’s chances of recovery.

The Other Instructions section of the form gives you the option of providing additional specific written instructions. This is where you may want to describe other conditions in which you would or would not want life-sustaining treatment. Other topics you may chose to address in this section are pain management, particular procedures, time limits on treatment, exceptional circumstances, hospice care, and any individuals you want to be excluded from making decisions on your behalf. You should also know that in the event you are pregnant, you will be provided life-sustaining treatment, including artificially administered hydration and nutrition, unless you specifically express in your own words in this section that such treatment should be withheld or withdrawn even if you are pregnant.

Keep in mind that a patient that chooses not to receive life-sustaining treatment will still receive care to make the patient comfortable, including controlling pain and managing symptoms. The focus of this care is not trying to cure the patient, but simply to make the patient and their loved ones as comfortable as possible during the process of illness, dying and bereavement.

Part II: Appointment of Health Care Proxy

In Part I you have expressed your wishes should you develop a terminal condition, become persistently unconscious or suffer from an end-stage condition. In Part II you appoint a health care proxy to make all other health care decisions on your behalf if you are unable to do so. This includes having access to your medical information and talking with your health care providers about treatment options. Your health care proxy may be asked to make decisions about administering or refusing medical tests or treatments, including life-sustaining treatments. In addition, this person is empowered to seek second opinions and make decisions about placing you in a health care facility, selecting hospice care, or transferring you into the care of another physician.

You should select one health care proxy and one alternate. These people must be at least 18 years old and of sound mind. Usually a spouse or adult child is appointed, but this is not required. If your first choice is your age or older, you may want to select a younger person as your alternate. When selecting your proxies consider the following:

• Have you confirmed that this person is willing to accept this responsibility?
• Will this person be available when needed?
• Is this person able to ask health care providers important questions and advocate on your behalf?
• Is this someone you trust?
• Is this someone that knows you well and knows your values?
• Will this person be able to handle conflict that may arise over your health care?
• Is this someone you can talk to frankly about your wishes?

Part III: Anatomical Gifts

This section is where you express your wishes regarding donation of your entire body or designated parts for transplantation or research. You mayselectthe purpose or purposes for whichthe giftisbeing madefrom the following choices:(1) transplantation; (2)therapy; (3) medical science, research, or education; and (4) dental science, research or education. These terms are not defined in the Oklahoma Advance Directive Act, they they are defined in the Comments to the Revised Uniform Anatonomical Gift Act (2006) as follows:

Transplantation refers to the removal and grafting of one individual’s body part into the body of another individual. [Note that many people suffering from illness or injury are on waiting lists for organ transplants. An organ donor is generally still able to have an open casket burial service. You are never too old to be an organ or tissue donor. Each potential donor will be evaluated at the time of death and being an organ or tissue donor will not affect the medical care you receive while you are alive.]