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Advance Directives

Make Your Wishes Known Before a Serious Illness Occurs

Advance directives are legal documents used to communicate your preferences about future health care. If you become incapacitated or unable to communicate, these documents spell out the types of care you do and don’t want to receive. It’s important to communicate your wishes to family, friends and health care professionals before a serious illness occurs.

Providence St. Mary Medical Center honors advance directives

Standard advance directive forms are available from Care Management staff at Providence St. Mary Medical Center or they can be downloaded here. Forms must be signed and dated in the presence of two witnesses. By law, witnesses can’t be family members.

For more information or help preparing an advance directive, call Chaplaincy Services at (509) 522-5807.

If you have an advance directive, make sure your family knows where to find it. It’s also helpful to file a copy with your family doctor and attorney. And, bring a copy to the hospital for a scheduled procedure. If you’re traveling, carry a copy with you.

Advance directives recognized in the state of Washington

Living Will: A Living Will – or Health Care Directive – covers care intended to sustain life if you are terminally ill or permanently unconscious. It provides a roadmap to doctors and family members in areas such as artificial feeding and hydration. It does not allow you to appoint a proxy to make decisions on your behalf.

Durable Power of Attorney for Health Care: A Durable Power of Attorney for Health Care covers more medical situations than a Living Will. The document allows you to state your wishes and appoint a proxy to make sure those wishes are honored. It goes into effect if you are unable to speak for yourself or under other circumstances you identify. It also allows your proxy to work with your physician to make health care decisions.

It’s a good idea to have a Durable Power of Attorney for Health Care witnessed and notarized, even though the State of Washington doesn’t require it. Many other states do.

Please note: a Durable Power of Attorney for Health Care is different than a durable power of attorney for financial matters, although they are often drafted at the same time.

Mental Health Advance Directive: A Mental Health Advance Directive describes your choices about mental health treatment. While you have the capacity to make choices for yourself, you can create a directive to tell a doctor, institution or judge which types of treatment or confinement you do or don’t want. You can also appoint a proxy to make mental health care decisions for you if you become unable to.

Physician Orders for Life-Sustaining Treatment (POLST): The Physician Orders for Life Sustaining Treatment (POLST) is a “portable” physician order form that gives directions regarding emergency life-sustaining treatment. It is called “portable” because it is intended travel with you from one care setting to another (for example, from the hospital to a transitional care facility). If you have an emergency at home, the form serves as the physician’s orders to the emergency response team for your care.

Frequently asked questions and life-saving treatments to consider

What is a code?
When a patient’s heart or breathing stops, a code is started. During a code, many different emergency procedures may be needed to restore life, including CPR, defibrillation (electric shock) and breathing assistance.

What is cardiopulmonary resuscitation (CPR)?
CPR is the most frequently used form of emergency life support. During CPR, the patient’s chest is compressed to help the heart pump blood. Oxygen is given to the patient through a breathing mask or by mouth-to-mouth.

Administering CPR and other emergency measures can cause complications:

  • Brain damage from lack of oxygen or blood to the brain while the heart is stopped
  • Skin burns from the defibrillator
  • Broken ribs, punctured lungs
  • Sore or damaged vocal cords
  • Broken teeth
  • Infection

What is intubation?
If a patient who has coded is not quickly able to breathe on his/her own, staff inserts a tube through the mouth or nose, into the trachea, to get oxygen into the lungs. The tube is connected to a ventilator (respirator). A patient can’t eat or talk with the tube in place and may experience anxiety. Sedatives can reduce symptoms.

Which medications might be used during a code?
Medications help to control the heart rate / rhythm and medications to increase blood pressure / circulation could be ordered during a code.

What is an IV?
IV (short for “intravenous”) refers to a catheter placed in a vein administer medication, fluid or nutrition to a patient. A short-term IV is usually inserted in the arm, while a long-term (called a “central line”) requires a larger vein found in the neck, chest or groin. “IV fluids” are used to hydrate a patient and are different than tube feeding. IV fluids provide hydration. Tube feedings provide nutrition. Intravenous fluids are helpful to hospitalized patients who aren’t drinking enough fluids or who receive IV medications.

IV fluids are not always helpful to a dying patient – and can cause discomfort. During end-of-life care, health care professionals must frequently reevaluate the value of IV fluids.

What are defibrillation and cardioversion?
Defibrillation uses electric shock to correct life-threatening, abnormal heartbeats. Cardioversion uses electric shock to correct abnormal, but not life-threatening heartbeats.

What is a temporary pacemaker?
A pacemaker sends an electrical signal to the heart to make it beat. A temporary pacemaker uses pads placed on the chest or a wire passed through a vein. The signal is different from the shock involved with defibrillation or cardioversion.

What is tube feeding?
A feeding tube provides nutrition to a patient who can’t swallow, either through a nasal gastric (NG) tube in the nose or mouth or through a gasterostromy or jejunostromy tube directly into the stomach or small intestine. Tube feeding can be short-term, long-term or permanent.

What is a Do-Not-Resuscitate order (DNR)?
The decision to accept or refuse emergency measures – such as CPR or artificial breathing – if a patient’s heart stops beating should be discussed with family members and physicians. Everyone should know the patient’s wishes. If a patient does not want emergency measures, the attending physician must write a Do-Not-Resuscitate order. Without it, everything will be done to prolong life. Patients can also make their wishes known through an advance directive such as a Living Will, Power of Attorney for Health Care, or Physician Orders for Life Sustaining Treatment (POLST).