Transcript Recent Changes to Oklahoma’s Advance Directive

Oklahoma’s Advance
Directives
Linda Edmondson, LCSW
First, the Advance Directive for
Health Care
• In the introduction: “If I am incapable of
making an informed decision regarding my
health care, I direct my health care
providers to follow my instructions below.”
• Two physicians must determine the
incapacity
The Advance Directive for Health
Care has two parts-• The first is the “living will” with instructions
for end-of-life care
• The second names a “health care proxy”
to speak on the patient’s behalf
In the living will section . . .
• There are three end-of-life conditions—
1. Terminally ill (within 6 months)
2. Persistently unconscious
(New--)
3. An end-stage condition
End-Stage Condition
“…caused by injury, disease, or illness,
which results in severe and permanent
deterioration indicated by incompentency
and complete physical dependency for
which treatment of the irreversible
condition would be medically ineffective…”
Three choices for each condition
• No life-sustaining treatment except tube
feeding
• No life-sustaining treatment including tube
feeding
(New)
• I direct that I be given life-sustaining
treatment and tube feeding
Blank lines
• Add instructions about other conditions
when treatment is desired or refused
• Make specific comments about tube
feeding, antibiotics, dialysis, pain
medications, hospice care, etc.
The Health Care Proxy
• The proxy is “…authorized to make
whatever medical treatment decisions I
could make if I were able, except that
decisions regarding life-sustaining
treatment and artificially administered
nutrition and hydration can only be made
as I have directed…”
• Two physicians must determine incapacity
Proxy has added powers
• With the recent changes in the law and
form, the health care proxy can make
other health care decisions, for instance….
• Hospice care
• Nursing home choice
• Consent for surgery
Choosing a proxy
• Name a trusted relative as proxy
• Consider naming an alternate in younger
generation
• Add identifying information and contact
numbers
• Talk to the proxy about your wishes
Remember
• The proxy can only make life-sustaining
treatment decisions following the wishes
outlined in the first sections of the
Advance Directive
Anatomical Gifts
For transplantation therapy
Or
Medical science, research or education
General Provisions
• Must be 18 years old to complete
• Witnesses must be 18 and not relatives or
inheritors
• In effect during pregnancy only if clarified
in patient’s own words
• Can be easily revoked
• Takes precedence over earlier documents
• Copies should be given to proxy, other
family, health care providers, etc.
Review Four Recent Major
Changes:
• In effect any time patient is incapacitated
• End-of-life conditions now include an
“end-stage condition”
• Clear choices about artificial nutrition and
hydration are given
Powers of the health care proxy are
expanded
Complete a new document
• The added powers of the new law and
form are so important . . .
• Complete a new one for yourself
• Begin to help your clients and patients
complete a new document
Important to remember:
• So long as the patient has the capacity to
make decisions, the Advance Directive is
not in use.
Important to remember:
• The health care proxy can make ALL
health care decisions ANY TIME the
patient is incapacitated and unable to
make decisions for himself or herself.
• Except . . .
. . . End-of-life decisions
• The health care proxy can only make endof-life decisions as outlined in the
document
And . . .
End-of-life Decisions
• After two physicians have determined that
the patient is
--Terminally ill (expected to die within six
months)
OR
--Persistently unconscious (persistent
vegetative state) OR
--In an end-stage condition
Another Advance Directive:
Durable Power of Attorney
• Most attorneys agree that a Durable
Power of Attorney for Health Care is no
longer needed for most people
Another Advance Directive:
The Do-Not-Resuscitate Order
• Goes into effect immediately
• Is a near-death document
• Can be signed by the patient, the health
care proxy, the agent of a durable power
of attorney for health care, or a guardian
• Transfers and remains in effect wherever
the patient is located
The Do-Not-Resuscitate Order
• On the other side the physician can sign
• Physician must know that the patient did
not want CPR in the circumstances
Hydration and Nutrition for
Incompetent Patients Act
• Very restrictive
• Assumes all incapacitated patients want
tube feeding
• Exceptions are very narrow
• So it is very important to make your
wishes known about tube feeding
Hierarchy of decision-makers
• There is no law in Oklahoma outlining the
hierarachy of decision-makers if a patient
is incapacitated and has left no
instructions for end-of-life care.
Questions?
• Contact information:
Linda Edmondson, LCSW
[email protected]
405-771-5556