ADVANCE DIRECTIVES: QUESTIONS AND ANSWERS

Prepared by:
The Clinical Ethics Center
Memorial Medical Center
701 North First Street
Springfield, IL 62781-0001
Phone: (217) 757-2353
Fax: (217) 757-2359

Description
Advance Directives allow anyone of sound mind over the age of 18 to communicate their health care preferences to friends and family before unforeseen health issues arise. These directives become active ONLY if you become unable to make decisions for yourself. As such, they are meant to provide guidance to those people who might need to make health care decisions for you.

'Advance Directives' is a general term used to describe different ways of documenting your health care wishes. In Illinois, the four primary forms of Advance Directives are: a Living Will, a Power of Attorney for Health Care, a Mental Health Treatment Declaration and the Illinois Department of Public Health sponsors a DNRorder/Advance directive for decisions regarding the administration of CPR. It is important to understand the purpose of each form - this information is designed to explain the forms and their differences. You may fill out any or all of these forms depending on your personal goals.

It is important to note that nursing and comfort measures designed to enhance comfort and to relieve pain and suffering will be provided to patients at all times. Furthermore, the dignity, social, psychological, and spiritual well-being of the patient will be protected at all times.

Are copies of the forms valid? - Yes.
Once the forms are properly witnessed, you should make additional copies of your Advance Directives and distribute them to your health care provider, agent(s), and family members. Be sure to discuss your wishes and values with those persons at the same time.

How long are they valid?
The Living Will and Power of Attorney for Health Care remain valid until you change them, verbally revoke them in the presence of a witness who can document your decision, or tear them up. They may be changed or revoked by you at any time.

LIVING WILL
The Living Will form allows a patient to specify in advance that she does not wish to receive health care treatment if she should suffer from an incurable or irreversible injury, disease, or illness, and is not able to make health care treatment decisions for herself.

When does it apply?
The Living Will applies only when it has been determined by a physician that the patient is sufferring from an incurable or irreversible condition. The Living Will only applies when the patient is unable to make decisions for herself; so long as she is able to make decisions, the Living Will cannot be invoked.

What treatments are covered?
The Living Will covers any treatment which might be considered life-prolonging, or artifically extending the dying process. A Living Will requires that comfort-care treatment always be provided.

Who can fill out a Living Will?
Anyone over the age of 18 and who is of sound mind can fill out a Living Will. It must also be witnessed by two adults. The Living Will can be revoked at any time by the patient simply tearing the form, or documenting the patient’s wish to revoke the form, or in writing by the patient.

DURABLE POWER OF ATTORNEY FOR HEALTH CARE
The Durable Power of Attorney for Health Care allows an individual to specify in advance who should make health care treatment decisions for her if she should become unable to make these decisions for herself.

When does it apply?
The Durable Power of Attorney for Health Care applies any time the patient is unable to make heath care treatment decisions for herself. Unlike the Living Will, the patient does not need to be suffering from a terminal, incurable or irreversible condition for the Durable Power of Attorney for Health Care to apply.

What treatments are covered?
The Durable Power of Attorney for Health Care provides the person named as "agent" with broad powers, to provide consent or refusal for any type of medical care or treatment.

Who can be named the agent?
Anyone over the age of 18 can be named the agent, except for the physician providing care to that patient. The agent named has no legal obligation to serve in this role.

Who can fill out a Durable Power of Attorney for Health Care?
Any adult of sound mind may fill out a Durable Power of Attorney for Health Care. It must also be signed by a witness. It may also be signed by the person(s) named as agent, but this is not required. The Durable Power of Attorney for Health Care can be revoked at any time, by the patient simply tearing the form or documenting the patient’s request to revoke the form, or in writing by the patient.

THE MENTAL HEALTH TREATMENT DECLARATION
The Mental Health Treatment Declaration allows an adult of sound mind to declare in advance her preferences or instructions for mental health treatment should she become unable to make decisions for herself due to the symptoms of a mental disorder, and to name an individual to make decisions on her own behalf.

When does it apply?
The Mental Health Treatment Declaration takes effect only after two physicians have determined that the patient is unable to make decisions for herself.

What treatments are covered?
The Mental health Treatment Declaration covers 3 types of mental health treatment: electroconvulsive treatment (ECT); psychotropic medication; and admission to and retention in a mental health facility.

Who can fill out a Mental Health Treatment Declaration?
Anyone 18 years of age or older, who is of sound mind (as confirmed by two adult witnesses, who do not need to be physicians) can fill out a Mental Health Treatment Declaration. The document must be signed by these two witnesses. The Mental Health Treatment Declaration can only be revoked in writing, and only when the patient has been determined by a physician to be capable of making health care treatment decisions.

UNIFORM DO-NOT-RESUSCITATE (DNR) ADVANCE DIRECTIVE
The Illinois Department of Public Health (IDPH) Uniform Do-Not-Resuscitate (DNR) Advance Directive allows you, in consultation with your physician, to make an advance decision that cardiopulmonary resuscitation (CPR) should not be attempted if your heart and/or breathing stops. Cardiopulmonary resuscitation (CPR) refers to various medical procedures used in an effort to restart a person's heart and/or breathing. In the absence of a Do-Not-Resuscitate (DNR) Advance Directive, health care professionals will automatically begin cardiopulmonary resuscitation (CPR) when an individual's heartbeat and/or breathing stop.

WHA T TREATMENTS ARE COVERED?
The Uniform D0-Not-Resuscitate (DNR) Advance Directive, when properly completed, instructs all Illinois emergency medical crews, physicians, nursing home and hospital personnel that you do not want them to use cardiopulmonary resuscitation (CPR) to restart your heart and/or breathing. Other treatments and measures to promote a patient's comfort and dignity will continue to be provided. You should not fill out a Do-Not-Resuscitate (DNR) Advance Directive if you want all resuscitation efforts under all circumstances.

WHO CAN FILL OUT A UNIFORM Do-Not-Resuscitate (DNR) Advance Directive?
Before completing a Do-Not-Resuscitate (DNR) Advance Directive, you must discuss this option with your physician. A physician must sign the form in order for it to valid. You should discuss your personal views, your current and future health, if you want cardiopulmonary resuscitation (CPR) in the event of an unforeseen accident or during surgery, and your views on other life support mechanisms. You are never required to complete a Do-Not-Resuscitate (DNR) Advance Directive as a condition of treatment or against your wishes.

The IDPH Uniform Do-Not-Resuscitate (DNR) Advance Directive requires your signature (or the signature of your legally authorized representative), the signature of two witnesses, and your physician's signature. The original Do-Not-Resuscitate (DNR) Advance Directive should be safely kept in your home to present to EMS personnel in case of an emergency call. Your physician should also have a copy for your medical files. All copies of the form are valid in the state of Illinois so you may want to consider giving copies to family members or keeping a copy with you if you travel.

What if I don't fill out an Advance Directive?
If you are unable to make health care decisions for yourself and don't have an Advanced Directive that specifies who you want to make those decisions for you, then the Illinois Health Care Surrogate Act (HCSA) tells care providers whom they may contact to make decisions for you (a surrogate decision-maker).

When does it apply?
The Act only applies when your physician has examined you and has documented that you do not have the ability to make health care decisions for yourself. Your physician may appoint a surrogate decision-maker according to the priority listed below. If your decision-making fluctuates, you can still make decisions when you are able, and your surrogate will make decisions when you are unable.

Your physician must inform you of the name of the person she/he has appointed as surrogate. You always have the right to object to the use of that person as surrogate decision-maker. If you object to the appointed person, another person will be appointed.

Who qualifies as a Surrogate decision-maker?
Surrogate decision-makers are appointed in the following order:
1. Patient's guardian
2. Patient's spouse
3. Any adult son or daughter of the patient
4. Either parent of the patient
5. Any adult brother or sister of the patient
6. Any adult grandchild of the patient
7. A close friend of the patient
8. The guardian of the patient's estate

If there are multiple decision-makers at the same priority level, they must make every effort to reach a consensus decision. If the decision can not be resolved, then the majority shall rule. The surrogate must base decisions as much as possible on your known wishes, religious beliefs, personal preferences, etc.