Advance Directives

PURPOSE

To establish procedures for complying with the Patient Self Determination Act regarding living wills, do not resuscitate (DNR) orders and/or durable power of attorney.

POLICY

Adult patients 18 years or older should communicate their wishes regarding advance directives to their significant others. This guides significant others and healthcare providers in following patients’ wishes should they become incapacitated or unable to make decisions.

State law recognizes the Ohio Advance Directive for Healthcare (Choices – Living Well at the End of Life, available on this website), which combines the best features of a Living Will and Power of Attorney for Healthcare into one written document.

• Living Will – A legal document informing the physician and health care provider of the life-sustaining treatments or procedures the patient wants when in a terminal condition or a persistently unconscious state.
• Appointment of Health Care Proxy (AHCP) – A legal document allowing the patient to appoint another person to make medical decisions should they become temporarily or permanently unable to make those decisions.
• Do Not Resuscitate (DNR) – A legal document stating the patient’s desire not to have cardiopulmonary resuscitation in the event of cardiac or respiratory arrest.

These documents will be collectively referred to as advance directive from here forward.

• The patient is responsible for informing their provider about any advance directive, including a living will and/or medical power of attorney that may affect their care.
• During the scheduling process, patients or their appointed healthcare proxy will be asked whether they have any advance directives. If so, patients are required to provide the document(s) which will be placed prominently in the patient’s chart.
• When the patient has indicated that they have an advance directive but have not provided a copy upon admission, an “essence” form is provided for the patient to indicate the nature of information contained on the patient’s advance directive. It is the responsibility of the receptionist to obtain this information and place it prominently in the Endoscopy Center chart.
• Advance directives or living wills will not be honored during the period of care at the facility. Due to   this policy, if the patient chooses to seek alternative care, the facility will provide the appropriate referral.
• Patients may request copies of the advance directive they provided by contacting the physician's office.
• Copies of the patient’s advance directive will be provided to any healthcare facility to which the patient is transferred.

CLEVELAND CENTER FOR DIGESTIVE HEALTHCARE AND ENDOSCOPY (AMBULATORY SERVICES)

For the purposes of this section, terminal condition and persistently unconscious are defined below:

• Terminal condition means an incurable and irreversible condition that, even with the administration of life-sustaining treatment, will, in the opinion of the attending physician and another physician, result in death within six (6) months. A patient would not be considered to have a terminal condition if, for example, he or she could be sustained for longer than six (6) months by use of a ventilator, artificially administered tube feedings, or similar artificial or mechanical means.
• Persistently unconscious means an irreversible condition, as determined by the attending physician and another physician, in which thought and awareness of self and environment are absent. The patient may be diagnosed as being persistently unconscious even though they could be kept alive for months or years using artificial life support.

This facility does not provide care to the persistently unconscious. The patient’s condition must be certified in writing by the attending physician and by a second physician, both of whom have recently and personally examined the patient. Any patient who does not have a terminal condition or who has a living will dependent on the clause persistently unconscious will be resuscitated following appropriate guidelines and transferred to a local facility. That facility will be responsible for determining persistent unconsciousness and complying with the patient's advance directive.

• If a patient with a terminal condition sustains a life-threatening event, resuscitation efforts and transfer to a local hospital will be initiated.
• If the patient is not persistently unconscious and does not have a terminal condition, but the patient or representative wishes to suspend life-sustaining treatment, they should consult legal counsel.