Advance Directives Frequently Asked Questions

 What 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:

Living 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.  

Appointment 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 Directive?  

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? 

The 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 facility
  • 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 yourself. 

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 Directive?  

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 mind. 

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 directive?
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.

Saint 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 extraordinary care.   

How do I get more information on Advance Directives? 

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