Advance Directives Notice

BAPTIST-PHYSICIANS’ SURGERY CENTER POLICY REGARDING ADVANCE DIRECTIVES

Baptist-Physicians’ Surgery Center’s (“BPSC”) policy is that patients or their legally authorized representatives have the right to participate in decisions relating to the patient’s health care.  BPSC recognizes a patient’s right to make and execute advance directives to express their wishes about health care or to appoint someone to make health care decisions when the patient is unable to make or communicate such decisions. HOWEVER, BPSC, AS AN AMBULATORY SURGERY CENTER THAT OPERATES EXCLUSIVELY FOR THE PURPOSE OF PROVIDING LOWER RISK SURGICAL SERVICES TO PATIENTS NOT REQUIRING HOSPITALIZATION, HAS A POLICY TO INITIATE RESUSCITATIVE MEASURES AND LIFE-PROLONGING TREATMENT IF THERE IS AN ADVERSE EVENT DURING THE PATIENT’S ADMISSION REGARDLESS OF THE CONTENTS OF ANY ADVANCE DIRECTIVE THE PATIENT MAY HAVE OR ANY INSTRUCTIONS FROM THE PATIENT’S REPRESENTATIVE.  In the event of an adverse event the patient will be transferred to an acute care hospital for further evaluation and treatment and any advance directive provided to BPSC will be transferred with the patient to the acute care hospital. If you do not desire to have surgery at BPSC due to its policy to always initiate resuscitation and provide life-prolonging treatment please contact BPSC and we will assist you in re-scheduling your surgery at another facility in conjunction with the assistance of your physician’s office.

Understanding Advance Directives and Kentucky Law LIVING WILL DIRECTIVES

If you are age 18 or over and of sound mind you have the right to make an advance directive to be used in the future if you cannot make or communicate health care decisions on your own. An “advance directive” is any kind of written document in which you “direct” how decisions are to be made about your medical treatment “in advance,” that is, before you become unable to make or communicate those decisions on your own. In “living wills” people spell out whether or not they want life-prolonging treatment. In “health care surrogate designations” people pick someone else to make medical treatment decisions for them. In advance directives for mental health people state which specific psychotropic medications they will not take and whether they will consent to have electroconvulsive therapy.  All of these are types of advance directives. A durable power of attorney may also be a type of advance directive.

You cannot be required to make an advance directive in order to get medical treatment, health insurance or for any other purpose. It is purely a matter of personal choice. If you cannot speak for yourself and you do not have an advance directive that covers the decision that is needed, the following people, in the order listed, are authorized by Kentucky law to make decisions for you that are in your best interest: (i) a guardian, if a court has appointed one for you; (ii) your husband or wife; (iii) your adult child, or if you have more than one, the majority of your adult children who are reasonably available to be consulted; (iv) your parents; (v) your nearest living relative, or if you have more than one relative of the same relation reasonably available for consultation, a majority of them. If you do make an advance directive it will only go into effect you can no longer decide for yourself, or communicate your decision.

A specific form adopted under Kentucky law known as a Kentucky Living Will Directive allows you to include one or more, or all, of the following: (i) directions that life-prolonging treatment be provided, not be provided, or once started, that treatment be stopped; (ii) directions that food and water be provided through artificial means, not be provided, or once started, that artificial food and water be stopped; (iii) a choice of one or more persons to act as your surrogate and make decisions for you; and (iv) a decision to donate your organs. You may also include any other special directions, so long as they are not prohibited by law or by accepted medical practice.

Life-prolonging treatment means treatment that uses machines or artificial devices to keep a vital body function going after it fails because of illness or injury such as ventilators to do the work of your lungs, dialysis to do the work of your kidneys, cardiac assist devices to take over for your heart, or tubes through which you are fed. These machines are only considered life-prolonging treatment when they will not help you recover and will only prolong your death.

If you have stated in your advance directive that you do not want life-prolonging treatment, then it will not be provided (unless you are pregnant) if your doctor and one other doctor agree that: (i) you are permanently unconscious; or (ii) you have a condition that cannot be cured and you won’t get better, and you are expected to die within a relatively short time and the treatment is only artificially prolonging the process of dying. Life-prolonging treatment that has been started before will also be stopped under these circumstances. You will still receive medicine for pain and any other care that you need for your comfort. Your Living Will Directive may also say that you refuse artificially-provided food and water, and that should be honored under the same circumstances as listed above (that is, if you are permanently unconscious or have a terminal condition).

HEALTH CARE SURROGATES

You have the right to appoint one or more health care surrogates that are 18 years of age or older to make medical decisions for you if you are not able to speak for yourself. The surrogate(s) you appoint cannot be employees, owners, directors or officers of a health care facility where you are receiving care (unless that person happens to be a close relative or a member of your religious order). If you name more than one person as your surrogate all of them must agree on any decision regarding your health care unless your advance directive states otherwise. If they cannot agree on a decision, your surrogate appointment will be disregarded and the health care decision will be made as if no surrogates had been named. 
The surrogate you appoint may make any medical care decision you could make yourself, except: (i) your surrogate may decide to withhold or stop artificial food and water only if death is expected in a few days, the feedings can’t be absorbed or digested, or if the burden of the tube feeding is greater than its benefit; (ii) your surrogate may not refuse or stop artificial food and water if you are permanently unconscious unless you have said in an advance directive that is what you want; and (iii) surrogates cannot reject life-prolonging treatment for pregnant women except in the limited circumstances above. Surrogates must honor wishes included in an advance directive, and must consider the advice of your doctor. 

DURABLE POWER OF ATTORNEY

A durable power of attorney is another form of advance directive that lets you name someone (called an attorney-in-fact) to make medical decisions for you if you are unable to speak for yourself. It is similar to naming a health care surrogate but you may also give your attorney-in-fact the authority to make decisions not only about your medical care, but also about your personal and financial affairs (e.g. power to write checks, pay your bills, file income tax returns or sell property.) No special form is required under Kentucky law, but certain special words must be included to show that you mean to give your attorney-in-fact the power to make medical choices for you when you can’t speak for yourself. A durable power of attorney must contain the words: “This power of attorney shall become effective upon the disability of the principal” or similar wording. Also, language should be included to specifically indicate that the attorney-in-fact has the authority to make health care decisions. If it does not state that health care decisions are included it may not be accepted by health care providers. You should talk with a lawyer if you want to make a durable power of attorney. 

MAKING AND KEEPING AN ADVANCE DIRECTIVE

If you want a Kentucky Living Will Directive form or an advance directive for mental health treatment BPSC can provide you one. Please call BPSC to have a form mailed to you or you may ask for a form when you come to BPSC. If you use a form be sure to read it closely and make certain it expresses your wishes. Also be sure to follow the instructions closely when filling it out. For example, the Kentucky Living Will Directive form must be dated and signed at the end by you and it must be witnessed by two witnesses or one notary public. Witnesses cannot be: (i) your blood relative; 
(ii) an heir to your estate; (iii) an employee of a health care facility or nursing home where you are receiving care (unless that employee is a notary public); (iv) your doctor; or (v)any person who must pay for your health care. If you want to use another form you may want to consult with a lawyer. 
Keep the original advance directive in a safe place, but do not put it in a safe deposit box, because you or your family may not be able to get to it if you need it in an emergency. Give family members or close friends copies.  Give one copy to your doctor and discuss it with him or her.  Your doctor will put the copy in your medical record. You are responsible for telling any health care facility that you have an advance directive. If you can’t do that for any reason, someone else may give the facility a copy.  Each time you go to a health care facility for care or treatment you may be asked whether you have an advance directive. 

REVOKING AN ADVANCE DIRECTIVE

You can revoke your advance directive at any time by: (i) stating that in a signed and dated writing;, or (ii) stating that orally in the presence of a health care provider and one other adult witness; or (iii) destroying your advance direc¬tive. If you choose to revoke your advance directive, be sure to immediately tell your doctor, any health care facility or nursing home where you are receiving care, any health care professionals who are caring for you in your home and family members or friends. 

ORGAN DONATION

A Kentucky Living Will Directive also allow you to indicate whether you wish to donate all or any part of your body for medical education, research or transplantation to a hospital, physician, medical or dental school, or to an individual in need of a transplant. Also, the gift may be made without specifying who is to receive it, which is not unusual. If you want more information about organ donation you may talk with your doctor or you can call Kentucky Organ Donor Affiliates at (800) 525-3456.