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Difficult Decision

Introduction

An important part of good medical care is respect for the dignity of patients. We, at The MetroHealth System, believe that respect for patients is best shown by offering information to patients and helping them take part in decisions about their care. The following is some information about your rights and duties in making decisions about your care. However, this cannot take the place of talking with the people who are caring for you. We hope you will talk to your medical team (doctor, nurse, social worker, nurse case manager, therapist, or chaplain) if you need help in making choices about your care.

Difficult Choices

Patients are admitted to the hospital for many reasons. Most patients will leave the hospital after a short stay. However, some patients may be very ill while in the hospital. Patients who are very ill may need complex treatment to keep them alive. These treatments include respirators (breathing machines), dialysis (kidney machines), surgery, feeding tubes, and many different kinds of medications. For many patients, these treatments work very well and are only needed for a short period of time. For other patients, these treatments may need to be used for a long period of time in order to sustain life. However, despite everything modern medicine has achieved, some patients may not survive.

Medicine has a strong tradition of maintaining life. This means that all patients will get life-sustaining treatments unless a clear decision has been made not to use them.

We know that not all patients will want these life-sustaining treatments if they are very ill. It is important for all of us to think about what treatments we might want if a serious illness should strike. If you have strong feelings about what kind of care you want or do not want, you should make sure your family and your doctor know your feelings. This information will help you make choices about your care during a serious illness.

General Information

  1. Competent persons are people who can make reasonable decisions about their own care. Patients who are very ill may not be competent and may be unable to make difficult decisions. Patients who are not competent need someone else to make decisions for them.
  2. A guardian is appointed by the court to make decisions for a person who is not competent. The Department of Social Work can assist when a patient needs a guardian.
  3. The attending physician is the chief doctor who is in charge of your care in the hospital.
  4. DNR orders are doctor’s orders in the chart that mean “Do Not Resuscitate.” These orders mean that if the patient’s heart or lungs stop working, then a breathing machine, pressing on the chest, and certain medicines will not be used. This means that patients with a DNR order will be allowed to die if their heart or lungs stop working.
  5. A Living Will is a written statement by a person that states what treatment they want or do not want if they become very ill.
  6. A Durable Power of Attorney for Health Care is a written statement that names someone else to make decisions if that person becomes very ill and the medical team cannot talk with the patient. Most people name a family member or a friend.
  7. A Living Will and Durable Power of Attorney together are Advance Directives. The Department of Social Work provides information and assistance to patients and family members in processing Advance Directives.

Our hospital’s policy, which complies with state law, is outlined below.

General Principles

A. When a person can make decisions for themselves:
  • Patients should be given all the information they need to help make decisions about their care.
  • All competent patients have the right to refuse any treatment. This includes treatments that might be used to maintain the person’s life. (Note: All patients will be given life-sustaining treatments in an emergency unless the person has clearly refused these treatments.)
  • DNR orders will only be written in the chart if the competent patients want a DNR order. DNR orders cannot be written in the chart without talking to the patient first. A patient can change their mind about a DNR Order at any time.
  • All adult patients will be asked whether they have a Living Will or a Durable Power of Attorney when they come into the hospital. If a patient has one or both of these, a copy should be put in the patient’s chart.
  • The hospital will have information for patients who want to know more about making a Living Will or a Durable Power of Attorney.
  • Sometimes doctors strongly disagree with the wishes of the patient. If this happens, then the doctor or the patient can ask that the patient’s care be switched to another doctor.
B. When a person cannot make decisions for themselves:
  • A person’s Living Will or a Durable Power of Attorney will be followed by the doctors if the person cannot make decisions for themselves. Having both a Living Will and a Durable Power of Attorney is the best way to make sure your wishes are respected.
  • A person’s wishes do not need to be written in a Living Will or a Durable Power of Attorney. If a person clearly told their family or their doctor what they would want if they got very ill, then those wishes should be followed according to the legal order of decision-making (spouse, adult children, parents, then siblings).
  • If a person has not told anyone what they would want, and if the person does not have a Living Will or a Durable Power of Attorney, a DNR order will only be written if the family members (see the above order of family) agree to the order.
  • If a seriously ill person does not have family or friends, and the person has not said what they would want, then the orders of two attending doctors are necessary to stop life-sustaining treatment.
  • Each person has different goals, beliefs, hopes, and fears.  Each person is also different in how illness affects them and in how well different treatments will work.
  • For all of these reasons, it is very important to talk to the person caring for you to make sure the best choices are made for you.
C. When there are disagreements: role of the Ethics Committee Consult Service
  • If you disagree with your medical treatment, you (or a family member) should speak with your doctor or nurse. Disagreements can usually be resolved with good communication.
  • If you still disagree with your treatment, you (or a family member) may call the hospital’s Ethics Consult Service. The Ethics Committee has members from many different professions. They can give advice in difficult situations. To reach the Ethics Consult Service, please call 216-778-8497, or use pager number 216-207-1095.
© Copyright 2002 - The MetroHealth System|2500 MetroHealth Drive|Cleveland, OH 44109|(216) 778-7800|All Rights Reserved.
  • © Copyright 2002 - The MetroHealth System
  • 2500 MetroHealth Drive|Cleveland, OH 44109|(216) 778-7800
  • All Rights Reserved.