Advanced technology has made true medical “miracles an everyday occurrence, from the tiny baby sustained by an incubator, to the recipient of a donated organ. Yet, with these remarkable advancements come additional responsibilities and sometimes, difficult decisions about when to withhold or withdraw treatment.
As an individual it is your right – and your duty to yourself – to understand as much as possible about your medical care. Your primary physician should be the main source of answers to your healthcare questions. Nurses, social workers, educators, and chaplains can be valuable sources of information as well.
The Patient Self-Determination Act
The patient Self-Determination Act is a federal law that requires hospitals to “provide written information” to adult inpatients concerning “an individual’s right under state law – to make decisions concerning – medical care, including the right to accept or refuse medical or surgical treatment and the right to formulate advance directives.”
To help patients make these choices, Kansas law provides for advance directives, and recognizes both a living will and durable power of attorney for healthcare. This brochure outlines what Kansas statutes require.
Advance directives are documents that state a patient’s choices about treatment including decisions to refuse treatment to be placed on life-support, and to stop treatment at a point the patient chooses. It also includes requesting life sustaining treatment if that is wanted.
There are several kinds of advance directives. Two are mentioned most often.
One is called a “Health Care Directive” and the other is called a “Durable Power of Attorney for Healthcare.” Through advance
directives, patients can make legally valid decisions about their medical treatment.
Health Care Directive
A Health Care Directive is a document that allows you to state, in advance, your wishes regarding the use of life sustaining procedures. It is implemented only when you are terminally ill, and do not have the capacity to make treatment decisions.
The Kansas living will is found in a statute titled “The Natural Death Act.” The statute allows any adult to sign a form (relating to themselves only) which states that life-sustaining procedures should be withheld or withdrawn when decision making capacity is lost and when such procedures would merely prolong death. Medical procedures deemed necessary to provide comfort or alleviate pain are not considered “life-sustaining procedures” under the act.
For the Natural Death Act Declaration to be effective, two physicians must personally examine the patient and determine that the patient has a terminal illness. The physicians must agree that death will occur whether or not the medical procedure or intervention is done. The form is not effective if the patient is pregnant. If you decide to create a Health Care Directive, it is your responsibility to notify the appropriate people – physicians, family, friends, clergy – and to provide them with copies of your signed Directive. You are encouraged to discuss the details of your Health Care Directive with them, and to have it made a part of your permanent medical record.
Durable Power of Attorney for Healthcare
A durable power of attorney for healthcare is a legal document that relates only to healthcare decision making. The person who would make the decisions is known as an “agent” and can be any adult except a physician or other healthcare provider (including people who work, own or are directors for hospitals and other healthcare institutions) unless the healthcare provider is related by blood or marriage to the person signing the document.
The powers which can be granted include: the power to make decisions, give consent, refuse consent or withdraw consent for organ donation, autopsy or the treatment of any physical or mental condition. The agent may also make all necessary arrangements for hospitalization, physicians or other care, and to request and receive all information and records and to sign releases for records.
The person signing the durable power of attorney for healthcare can choose which of the above powers the agent will have. Specific instructions can be given. For example, a specific treatment may be prohibited. Requests for treatment, including life-sustaining care, can also be included. The special instructions allow the durable power of attorney for healthcare to be specific for each individual. The agent and the healthcare provider must follow the patient’s expressed wishes. This means that they must also respect any wishes that are stated in the Health Care Directive. Unless limited, the durable power of attorney for healthcare allows the agent to make decisions about withholding or withdrawing life-sustaining treatment in all types of illness (including comas or persistent vegetative states) and is not limited to terminal illness.
To be effective, the document should be notarized.
Here’s How It Works
1. You have the right to information about your medical condition, diagnosis, prognosis and possible treatments. You also have the right to refuse any treatment including life-saving medical treatment.
2. A representative of the medical center will talk to you about your rights outlined above and your right to make advance directives. You also have the right to not make advance directives. That is your choice.
3. You may choose a durable power of attorney for medical decisions and a Healthcare Directive. A durable power of attorney for medical decisions designates a particular person to make decisions for you when you are not able to decide for yourself and can cover all healthcare decisions. A Health Care Directive states your wishes about withholding or withdrawing life-sustaining care.
4. If you choose to make advance directives, the medical center will provide the necessary forms. You do not need a lawyer in order to make an advance directive. However, legal advice is certainly appropriate. There are options other than the forms provided in the Kansas statute that are legal and can be used, including the forms developed by the agencies listed in this brochure.
5. Health Care Directives must be witnessed by two adult people. A durable power of attorney for healthcare should be notarized.
6. If you make advance directives, you should discuss them with both your family and physician. You are responsible for making copies available to him or her and all other doctors you deal with. You should also discuss and share copies of your advance directives with your family members. It is always a good idea to keep the original copy in a safe place.
7. If you wish to change your mind about your advance directives at a later date you may do so. You can revoke the old document(s) and make new advance directives that should also be notarized.
If you should have further questions, would like more information about advance directives, or would like to obtain the appropriate forms, please refer to the list below for some resources:
Pastoral Care Department
Golden Belt Home Health & Hospice
3520 Lakin Suite 102
Great Bend, KS 67530
Barton Co. Extension office
1800 12th St.
Great Bend, KS 67530
Center for Practical Bioethics
1111 Main St.
Kansas City, MO 64105
Kansas Bar Association
1200 S.W. Harrison
Topeka, KS 66612