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Advance Directives

Make Your Healthcare Wishes Known

If you were unable to communicate your care preferences to a healthcare team, who would you want to make those decisions for you? Have you named someone on a Durable Power of Attorney for Healthcare document that will carry out your wishes?

Download a printable PDF of an advance directive packet below.

Advance Directive Packet

View/Download the Advance Directive brochure

See Advance Directive policy

What are Advance Directives?

Advance Directives are legal documents in which patients express their wishes about the kind of health care they want to receive should they become unable to make their own treatment decisions.

What is a Living Will Declaration?

The Living Will is the patients’ statement about the use of life prolonging measures such as respirators (ventilators), tube feedings (nourishment), IVs, and CPR when they have reached a point where no hope of recovery exists. The Living Will simply requires the withholding or withdrawal of life prolonging treatment.

  • When does it apply?
    The Living Will goes into effect only when two physicians determine that the patient is unable to make their own decisions and are either in an irreversible coma or suffering from a terminal illness.
  • What treatments are covered?
    The Living Will permits the withholding or withdrawal of any treatment that might be considered life prolonging or that artificially extends the dying process.
  • Who can complete a Living Will?
    Anyone over the age of 18 who is of sound mind can complete a Living Will. It must be witnessed by two adults or notarized.
  • Can a Living Will be revoked?
    A Living Will can be revoked at any time. Patients can fill out a Revocation Form at any one of our Holzer locations.

What is a Durable Health Care Power of Attorney?

A Durable Health Care Power of Attorney allows patients to specify, in advance, who should make their health care decisions for them in the event that they are unable to make decisions for themselves. This individual is considered the “agent” or the “attorney-in-fact” for the patient.

  • When does it apply?
    A Durable Health Care Power of Attorney goes into effect only when two physicians determine that the patient has lost the capacity to make health care decisions.
  • What treatments are covered?
    A Durable Health Care Power of Attorney allows the patients to select broad or specific powers to provide consent or refusal for any type of health care, Durable Health Care Powers of Attorney are thus flexible documents allowing both the naming of an agent to make decisions for the patient when the patient is unable to do so and specification of the treatments that the patient wants or does not want to receive.
  • Who can be names as an agent?
    Anyone over the age of 18 years can be named as the agent except for the physician (and those employed by the physician) who is providing care to the patient. The agent named has no legal obligation to serve and the agent is not responsible for the financial costs associated with treatment.
  • Can more than one agent be named?
    Only one agent can serve at a time, but other individuals can be named as successor agents if the first individual named as the agent is not able or is unwilling to serve.
  • Who can complete a Durable Health Care Power of Attorney?
    Any adult of sound mind may complete a Durable Health Care Power of Attorney. The Durable Health Care Power of Attorney document must be witnessed by two adults or notarized.
  • Can a Durable Health Care Power of Attorney be revoked?
    A Durable Health Care Power of Attorney can be revoked at any time. Patients can fill out a Revocation Form at any one of our Holzer locations.

What is a Determination of Resuscitative Status (DNR)?

A Do Not Resuscitate (DNR) is an order that indicates the patient has elected to decline Cardiopulmonary Resuscitation (CPR) in the event that their heart or breathing stops. A DNR order is written by the patients’ provider after discussing the risks and benefits of CPR with the patient or their representative.

  • A new DNR order must be written at each visit if the patients’ wish to remain a DNR status.
  • The DNR order may be written to reflect a patient’s or surrogate’s expressed wishes about resuscitation or because the patient will not benefit from resuscitation. For example: for someone with a Living Will or Durable Health Care Power of Attorney, CPR may be appropriate if they are suffering from an acute life-threatening condition. Patients with Advance Directives may want aggressive treatment for potentially reversible conditions.
  • REMEMBER: Do Not Resuscitate should NOT be interpreted as Do Not Treat!
    • For example: A 70 year old patient with a history of COPD and Congestive Heart Failure (CHF) presents to the Emergency Department for septic shock, most likely from a secondary urinary tract infection but has a DNR on file. The Emergency Department Provider still needs to order appropriate testing, and aggressively treat the patient with antibiotics and intravenous fluids (if needed). Many patients still want either full aggressive or limited treatments focused on life-prolongation.

What is a Declaration of Mental Health?

A Mental Health Declaration is a form that allows patients to state their preferences regarding their mental health treatment and to select a person to make mental health care decisions for them when they cannot make these important decisions for themselves.

Who can I call for health regarding Advance Directives?

For questions or assistance, please contact:

  • Gallipolis:
    • Patient Experience Representative: 740-446-5604 or 740-925-3785
    • Care Management: 740-446-5393
    • Corporate Compliance: 740-446-5434
  • Holzer Medical Center - Jackson
    • Patient Experience Representative: 740-395-8457
    • Care Management: 740-395-8305
    • Corporate Compliance: 740-446-5434
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