End of Life Decisions . . . It's Up To You

An important message about Advance Directives to patients, families and friends — from all of us who care for you at Whidbey General Hospital

Why should I have to be making decisions now about dying?
Now is the very best time to be starting this process, because you have the time to calmly review the various kinds of life support which technology has made possible, and decide just how aggressively you would want to be treated if you are seriously or terminally ill.

What if I was in a bad accident today? I might want something different than if I were at the end stage of some disease . . .
Exactly! Your wishes are almost certain to evolve as you go through life. That’s why continuing an active dialogue with your doctor, your caregivers, and family is so important.

Okay; I get to the hospital in very bad shape and can’t speak for myself. What then?
If you’ve given a current Living Will (or Directive to Physicians) to your doctor, or had it added to your hospital records, we’ll know what you want done if the need arises. Without one we must assume you want the most aggressive treatment. But for some people, the quality of their life is more important than the length of their life.

So what’s the right decision?
Only you can say. Whatever the decision, it’s the right one if it’s yours. Knowing your wishes will help us to follow them, secure in the knowledge that we’re caring for you exactly as you would want.

What if I start off wanting "everything" done to keep me alive, and then decide I’ve had enough?
Again, it’s your decision. You and your care provider will talk through the options and determine which measures you no longer want carried out. These might include such measures as using drugs to treat rapid or erratic heart beats, artificial feedings, CPR (cardio-pulmonary resuscitation), applying an electric shock to restart your heart, inserting a breathing tube if you can’t breathe, or any combination of these. Your status could be changed from "Full Code" to "DNR" (Do Not Resuscitate) with whatever exceptions you think are still appropriate. If you opt for "Comfort Measures Only," you can always change your mind and request more aggressive treatment. Regardless of the choices you make, you will be taken care of.

So, is that all there is to preparing an Advance Directive?
It’s a major step toward knowing your wishes will be honored. But let’s say a neighbor calls an ambulance after finding you unconscious in your home.

The ambulance crew is obligated to treat you aggressively unless there is a POLST form posted. POLST stands for "Physician Orders for Life-Sustaining Treatment." Prepared with your care provider, the POLST can also be revoked at any time. If you decide you want ‘heroics’ limited, you will want to be sure the ambulance crew also follows your Directives. Give the POLST form to the ambulance crew so they know your wishes.

If I can’t speak for myself, how will my caregivers know what I want done?
Washington State recognizes your right to grant a "Durable Power of Attorney (DPOA) for Health Care." This would be a family member or friend who knows you well and you can trust to carry out your wishes. Your Health Care Power of Attorney can be changed just as your Advance Directives and the POLST can be. It’s essential that the person you name is thoroughly familiar with your wishes. This can come only after a full and frank discussion, repeated from time to time - and certainly whenever your life choices change.

What if I haven’t named my Power Of Attorney for Health Care as my proxy?
Then we’ll go by your Living Will, of course. If further decisions need to be made, and you’re unable to talk to us, the law requires that we consult with (in this order):

• Your court appointed guardian;
• your spouse;
• your adult children (who must all agree);
• your parents (who must both agree); and finally,
• your adult brothers and sisters (who must all agree).

As you can imagine, your critical condition could be a time of great stress for your family. Designating one family member, or perhaps a trusted friend, as your Power of Attorney for Health Care can help avoid the nightmare of indecision and bring great relief to the people who love you the most.

What if my Health Care Provider or the hospital do not agree with my choices?
Individual professionals or institutions cannot be forced to provide services that conflict with their professional, moral, or ethical values. If Whidbey General—or a doctor on staff—is unable to comply with a directive you or your Power of Attorney provide, we will assist in transferring your care to a provider who can. If you have concerns that your (or your family member’s) directives are not being honored, please contact the Director or Manager for that area or unit.

So how do I get all this done?
We’ve talked about three documents. Example forms for the Living Will and the Durable Power of Attorney for Health Care are included in this brochure. These forms do not need to be notarized. The Living Will needs signatures of two witnesses (who cannot be your care providers, be related to you, and will not inherit anything from you). Once you’ve completed these forms, you’ll want to have copies for your hospital record, your doctor’s office, your designated DPOA, any other care providers, and a spare set to take traveling. The POLST can be obtained from many health care providers, and requires your doctor’s signature in addition to your own.

The choices are yours - and that’s just as it should be.
If you have further questions about Advance Directives, 
ask your health care providers, your religious advisor or your attorney.