are Advance Directives?
"Advance directive" is a general term that refers
to your oral and written instructions about your future medical care, in the
event that you become unable to speak for yourself. Each state regulates the
use of advance directives differently. In
Connecticut, there are two types of advance directives:
- A living will
- Appointment of a healthcare representative
These directives may be used separately or in combination with each
other. If they are used together, it is
important to state which one will take precedence if they seem to conflict. They are defined as follows:
Will: A living will is a document that states your wishes
regarding any kind of healthcare you may
receive. Should you be in a terminal condition or permanently unconscious, the living
will can also tell your physician whether you want "life support
systems" to keep you alive, or whether you do not want to receive such
treatment, even if the result is your death. A living will goes into effect only when you
are unable to make or communicate your decisions about your medical care.
of Healthcare Representative: A healthcare representative is a person whom
you authorize in writing to make any and all healthcare decisions on your
behalf, including the decision whether to withhold or withdraw life support
systems. A healthcare representative does not act
unless you are unable to make or communicate your decisions about your medical
care. The healthcare representative will make decisions on your behalf based
on your wishes, as stated in a living will, or as otherwise known to your healthcare representative. In the event your
wishes are not clear, or a situation arises that you did not anticipate, your
healthcare representative will make a decision in your best interests, based
upon what is known of your wishes.
Must I have an advance directive?
No. You do not have to make a
living will or other type of advance directive to receive medical care, or to be
admitted to a hospital, nursing home, or other healthcare facility. No person
can be denied medical care or admission based on whether they have signed a
living will or other type of advance directive.
Why should I consider having an Advance
directives give you a voice in decisions about your medical care when you are
unconscious or too ill to communicate, or if you lose decision-making
capacity. As long as you are able to
express your own decisions, your advance directives will not be used, and you
can accept or refuse any medical treatment. But if you become seriously ill, you may lose
the ability to participate in decisions about your own treatment. Advance Directives help your healthcare
provider and loved ones know what your wishes are about treatment, and decide
what care you would or would not want if you are unable to speak for
yourself. They may help to provide your loved ones with peace of
mind about decisions they may have to make on your behalf.
Who can I name as
my healthcare representative?
following persons cannot be named your healthcare representative:
- Your physician
- If you are a patient at a
hospital or nursing home or if you have applied
for admission, the operators, administrators, and employees of the
- An administrator or employee of
a government agency responsible for paying for your medical care
Other than these restrictions, you can name anyone you feel
is appropriate to serve as your healthcare representative. Of course, you should speak to the person whom
you intend to name and be sure of his or her willingness to serve and to act on
your wishes. It is most important that
you select someone who will listen to your goals of care, and be able to carry
out your wishes for you if you are unable to communicate them for
What should I discuss with my healthcare representative and healthcare provider?
In many cases, an Advance Directive is only as good as the conversation that surrounds
it. That is why it is important that you
talk to those people who are likely to be involved in decisions about your care, such as your appointed healthcare representative, healthcare provider,
pastor, friends, and family. Topics for discussion might include:
“When I think of serious illness, what concerns me most is
. . . ” or “When I think of serious illness, what is most important to me is . .
“My most important goals and values are . . . “
“If my family needs to make decisions about my medical care, I would want them to take into account. . ."
“These are situations under which I do or do not want
life-prolonging interventions. . . ”
“Near the end of life I want to be treated . . . “
“If my Living Will and Healthcare Representative disagree,
priority should be given to. . .”
I am currently
healthy. Why do I need an Advance
The best time to fill out an
Advance Directive is when you are healthy. Discussions of goals of care and wishes for treatment are able to be
more objective and free from emotional distress. It may be helpful to view an Advance
Directive in the same way we view life insurance: we should have it in
case we need it in order to help provide for and comfort our loved ones
regarding decisions they have to make regarding our care. It can be a gift of greater peace of
After signing an Advance
Directive, to whom should I give copies?
You should consider making copies of your Advance Directive for your personal
records, your family, your physician, your attorney, your healthcare proxy, and your alternate healthcare proxy. Have additional copies ready to take with you
when you require hospitalization or other care, as your healthcare providers
will need a copy for your medical record. You should keep a list of persons to whom
you have given a copy of your Advance Directive so that if you later change it
or revoke it, you may collect the copies.
Do I need a lawyer to create an advance
No. You do not need a lawyer to create an advance directive. However, you must sign the document in the presence
of two witnesses in order for the advance directives to be valid. The
witnesses then sign the form.
After I complete an advance directive, can
I revoke it?
Yes. You can revoke
your living will or appointment of a healthcare representative at any time. A
living will can be revoked either orally or in writing. If you sign a new
living will, it may revoke any prior living will you made. However, to revoke
your appointment of a healthcare representative, you must do so in writing
that is observed and signed by two witnesses in order for the revocation to be
valid. Remember whenever you revoke an advance directive to tell your physician
and others who have copies of your advance directive.
Francis Hospital and Medical Center is a Catholic hospital. Will my Advance Directive be honored?
Advance Directives are a way to
promote human dignity and safeguard patient autonomy. In following the Judeo-Christian Tradition, as
well as the Ethical and Religious
Directives for Catholic healthcare Services (5th ed.), Saint
Francis Hospital and Medical Center recognizes “the
truth that life is a precious gift from God has profound implications for the
question of stewardship over human life. We are not the owners of our lives
and, hence, do not have absolute power over life. We have a duty to preserve
our life and to use it for the glory of God, but the duty to preserve life is
not absolute, for we may reject life-prolonging procedures that are insufficiently
beneficial or excessively burdensome.” As
such, “the free and informed judgment made by a competent adult patient
concerning the use or withdrawal of life-sustaining procedures should always be
respected and normally complied with, unless it is contrary to Catholic moral
teaching.” (ERD #59)
An individual has a moral obligation to
accept appropriate or “ordinary” care, but does not have an obligation to
accept or continue “extraordinary” care.
Ordinary care is defined as care that provides reasonable hope of
medical benefit to the patient, and does not pose undue burden. Extraordinary care is defined as care that
provides little or no medical benefit to the patient and/or is excessively
burdensome to the patient. Advance
Directives can help patients guide loved ones and healthcare providers in
following their wishes regarding the provision, withholding, or withdrawing of
How do I get more information on Advance
Information on Advance Directives, a PowerPoint
presentation, as well as the Advance Directive forms themselves are available
on the Ethics at Saint Francis website at http://saintfranciscare.com/ethics/. In addition, the State of Connecticut Summary
of Health Care Law regarding Patient Rights to Make Health Care Decisions is
available at http://www.ct.gov/ag/lib/ag/health/yourrightstomakehealthcaredecisions2011version.pdf