Advance Directives

Advance Directives

What is an advance directive?

An advance directive tells your Attending Physician (AP) what kind of care you would like to receive if you become unable to make medical decisions (if you are in a coma, for example). A good advance directive describes the kind of treatment you would want to receive depending on how sick you are. For example, the directives would describe what kind of care you want if you have an illness that you are unlikely to recover from, or if you are unconscious. Also, advance directives usually include certain kinds of treatment you would not want to receive. However, they can also say that you want to receive a certain treatment no matter how ill you are.

Advance directives can take many forms - a living will, a special power of attorney or a do not resuscitate order.

What is a living will?

A living will is one type of advance directive. It is written, legal document that describes the medical treatments or life-sustaining treatments you would want if you were seriously or terminally ill. A living will doesn't let you select someone to make decisions for you.

What is a special power of attorney for health care?

A special power of attorney (SPA) for health care is another kind of advance directive. A SPA states whom you have chosen to make health care decisions for you. It becomes active any time you are unconscious or unable to make medical decisions. A SPA is generally more useful than a living will. But a SPA may not be a good choice if you don't have another person you trust to make these decisions for you.

What is a do not resuscitate (DNR) order?

A DNR is a request not to have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. (Unless given other instructions, hospital staff will try to revive all patients whose hearts has stopped or who have stopped breathing.) You can use an advance directive form or tell you AP that you don't want to be resuscitated in case this happens. In this case, a DNR order is written in your medical chart by your AP. A DNR is usually discussed by the health care team with the relatives of patients without other advance directives in situations like: a comatose patient, persistent vegetative state, and brain death.

Should I have an advance directive?

By creating an advance directive, you are making your preferences about medical care known before you're faced with a serious injury or illness. This will spare your loved ones the stress of making decisions about your care while you are sick. Any person 18 years of age or older can prepare an advance directive.

People who are seriously or terminally ill are more likely to have an advance directive. Someone with terminal cancer might write that she does not want to be put on a respirator if she stops breathing. This action can reduce her suffering and increase her peace of mind. However, even if you are in good health, you might want to consider writing an advance directive. An accident or serious illness can happen suddenly, and if you already have a signed advance directive, your wishes are more likely to be followed.

How can I write an advance directive?

You can write an advance directive in several ways:

• Use a form provided by your doctor.
• Write your wishes down by yourself.
• Seek the advise of a lawyer.

Advance directives/ living wills/ special power of attorney do not have to be complicated legal documents. They can be short, simple statements about what you want done or not done if you can't speak for yourself. Remember, everything should be in conformity with Philippine law. You may also want to have what you have written reviewed by your doctor or lawyer to make sure your directives are understood exactly as you intended. When you are satisfied with your directives, the orders may be notarized (if possible), and copies should be given to your family and your attending physician.

Can I change my advance directive?

You may change or cancel your advance directive/ special power of attorney at any time, as long as you are considered of sound mind to do so. Being of sound mind means that you are still able to think rationally and communicate your wishes in a clear manner. Again, your changes must be made, signed, and if possible, notarize. Make sure that your AP and any of the family members who knew about your original directives are also aware that you have changed them.

If you do not have time to put your changed in writing, you can make them known while you are in the hospital. Tell your AP and any family or friends present exactly what you want to happen. Usually, wishes that are made in person will be followed in place of the ones made earlier in writing. Be sure your instructions are clearly understood by everyone you have told.

Definitions to Know

Advance directive/ special power of attorney

A written document (form) that tells what a person wants or doesn't want if he/she in the future can't make his/her wishes known about medical treatment.

Artificial nutrition and hydration

When food and water are fed to a person through a tube.

Autopsy

An examination done on a dead body to find the cause of death.

Comfort care

Care that helps keep a person comfortable but doesn't make him/her get well. Bathing, turning and keeping a person's lips moist are types of comfort care.

CPR (cardiopulmonary resuscitation)

Treatment to try to restart a person's breathing or heartbeat. CPR may be done by pushing on the chest, by putting a tube down the throat or by other treatment.

Special power of attorney for health care

An advance directive that names someone to make medical decisions for a person if in the future he/she can't make his/her own medical decisions.

Life-sustaining treatment

Any medical treatment that is used to keep a person from dying. A breathing machine, CPR, and artificial nutrition and hydration are examples of life-sustaining treatments.

Living will

An advance directive that tells what medical treatment a person does or doesn't want if he/she is not able to make his/her wishes known.

Organ and tissue donation

When a person permits his/her organs (such as the eyes or kidneys) and other parts of the body (such as the skin) to be removed after death to be transplanted for use by another person or to be used for experimental purposes.

Persistent vegetative state or irreversible coma

When a person is unconscious with no hope of regaining consciousness even with medical treatment. The body may move and the eyes may be open, but as far as anyone can tell, the person can't think or respond (comatose). Another term for this is a state of being clinically dead.

Terminal condition

An ongoing condition caused by injury or illness that has no cure and from which doctors expect the person to die even with medical treatment. Life-sustaining treatments will only prolong the dying process if the person is suffering from a terminal condition.

For further information, please consult your attending physician. 

You may also contact the Customer Service Division at tel. no.: (632) 988-1000 / (632) 988-7000 ext. 6198.