Many people are worried about the medical care they would be given should they become terminally ill and unable to communicate. They may not want to spend months or years dependent on life-support machines, or they may want every effort to be taken to sustain their life.
You Have a Choice
A growing number of people are taking action before they become seriously ill. You may now state your health care preferences in writing, while you are still healthy and able to make such decisions.
Under federal law, The MetroHealth System is required to provide you, the patient, an explanation of your rights under Ohio law to make personal decisions regarding your own medical care. We are also required to ask you whether you have written down your wishes.
This section explains your options concerning the right to accept or refuse medical treatment and how you may make your wishes known about the care you want when you are unable to decide for yourself. This is not legal advice, but it serves as general and useful information designed to help you understand your rights under the law.
Q. What are my rights regarding medical treatment decisions?
You have the right to make your own medical treatment decisions. If you do not want certain treatments, you have the right to tell your doctor you do not want them. Most patients can express their wishes to their doctor, but some who are seriously injured or unconscious cannot. However, you have the right to make your wishes known before such a situation occurs.
Q. What if I am too sick to decide or unable to communicate my wishes?
Sometimes people cannot tell their doctor about the kind of care they want because they become too sick and are unable to communicate. Under Ohio law, you have the right to fill out a form, while you are still able, that tells your doctors what you want done if you are unable to communicate your wishes.
Q. What kinds of forms are available?
Under Ohio law, there are two different forms you can use to make your wishes known:
Durable Power of Attorney for Health Care: This form allows you to appoint someone as your agent to make all health care decisions for you, should you become unable to communicate, or unable to make decisions for yourself.
Living Will: This form allows you to give advance written directions about all your health care decisions when you are terminally ill and unable to communicate or in a permanently unconscious state. These documents are also referred to as advance directives because they are signed in advance to let your doctor and others know your wishes concerning medical treatment.
Q. Are these my only alternatives?
No. You can decide that you would like to be designated as "do not resuscitate." This specifies that you do not want resuscitative measures, including defibrillation, cardioversion, chest compressions, etc. You will receive only comfort care.
Q. Do I have to fill out these forms before I get medical care?
No. No person or health care provider can require you to complete any of these forms. Completing any of these forms is a voluntary action on your part.
Q. Who can fill out these forms?
Anyone at least 18 years old who can make their own decisions can fill out these forms. A patient or surrogate decision-maker can complete a Do Not Resuscitate (DNR) form in conjunction with their primary care physician, clinical nurse specialist (CNS) or certified nurse practitioner (CNP).
Q. Do I need a lawyer?
No. You do not need a lawyer to fill out the forms. You may choose to discuss these matters with a lawyer, but there is no requirement to do so.
Q. Do my health care providers have to follow my instructions?
Yes. If your directions comply with state law. However, Ohio law includes a conscience clause in case your health care provider is unable to follow your directions because they are in conflict with the caregiver's conscience. In this case, you can be transferred to another health care provider who will comply with your wishes.
Durable Power of Attorney for Health Care
Q. Who should I choose to make all my health care decisions for me when I am unable to?
You can choose any adult relative or friend you trust to speak for you when you are unable to make your own decisions. Be sure you talk with that person about what you want. Then, write down what you want or do not want on your Durable Power of Attorney form. You should also talk to your doctor about your wishes.
Q. When does my Durable Power of Attorney take effect?
This document becomes effective whenever you lose the ability to make your own decisions, even if only temporarily. At these times, health care decisions will be made by the person you designate.
Q. What is the basic difference between a Durable Power of Attorney and a Living Will?
Your Living Will is your set of written instructions about the type of health care treatment you want when you are terminally ill and unable to communicate your wishes or when you are permanently unconscious. Your Durable Power of Attorney allows you to choose a person to make your health care treatment decisions for you when you are unable to do so yourself.
Q. If I have a Durable Power of Attorney, do I need a Living Will, too?
Many people choose to have both documents. A Living Will gives specific instructions directly to your doctors and applies only when you are terminally ill and unable to communicate your wishes or if you are permanently unconscious. A Durable Power of Attorney appoints another person you have chosen to make health care treatment decisions for you whenever you are unable to do so yourself.
Note: In the event that a Durable Power of Attorney and a Living Will conflict, the patient's wishes as stated in the Living Will shall prevail.
Q. How does a Living Will work?
It becomes effective only when you are permanently unconscious or terminally ill and unable to communicate. It spells out to what extent you want life-support technology used to prolong your life. It gives your caregivers the authority to follow your instructions regarding the medical treatment you want under these conditions.
A Patient Without a Durable Power of Attorney or a Living Will
Q. If I do not have a Living Will or a Durable Power of Attorney, who makes my health care decisions when I am terminally ill and unable to communicate or in a permanently unconscious state?
Ohio law recognizes an Order of Decision Makers when you are no longer able to make health care decisions for yourself. The law allows next of kin:
- To make all your health care decisions if you are terminally ill and unable to communicate
- To make decisions for the withdrawal of life-support if you are in a permanently unconscious state only after a 12-month waiting period
- The order of decision makers is legal spouse, adult children, parents, siblings
Other Matters to Consider
Q. What about the withholding of artificially supplied food and water?
The issue of whether you can authorize the withholding of artificially supplied food and water (enternal feeding and fluid tubes) depends on your medical condition.
- If you are terminally ill and unable to communicate, and if your Living Will or Durable Power of Attorney states that you do not want artificially supplied food and water used to prolong your life, then these may be withheld.
- If you are in a permanently unconscious state, artificially supplied food and water may be withheld only if you have included a statement allowing for this and have initialed and/or signed the specific statement allowing for this in your Living Will or Durable Power of Attorney.
- If you do not have either of these forms, Ohio law allows your next of kin to authorize the withholding of artificially supplied food and water when you are terminally ill and unable to communicate. If you are in a permanently unconscious state, your next of kin can make these decisions for you only after a 12-month waiting period and approval from a Probate Court.
Q. By filling out these forms, am I participating in euthanasia or assisted suicide?
No. Ohio law does not allow or condone euthanasia or assisted suicide.
Q. Can I make changes to my forms?
Yes, at any time. It is always a good idea to periodically review your forms to be sure they still reflect your views.
Q. Where do I get Living Will and Durable Power of Attorney forms?
If you are interested in receiving copies of these forms, ask your health care provider.
Q. What do I do with my forms after filling them out?
You should give copies to your doctor and health care facility to put into your medical record. MetroHealth can scan your directives into your electronic medical record. Be sure to tell your family or friends, and people close to you, about what you have done and consider giving them a copy as well. Do not simply put these documents in a safe place and forget about them.
Q. Can my signed Living Will and/or Durable Power of Attorney for health be filed anywhere for easy access by health care providers at a later date?
Yes. The County Recorder will maintain a record of these, if you choose to register them. Simply complete the form as required, and contact the County Recorder for further handling.