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Advance Directives & Living Wills

Advance Directives
Decisions about life-prolonging treatments are often difficult and require careful consideration. These decisions ideally should be made before a time of crisis, since full treatment will be carried out unless the healthcare team has been instructed otherwise. Such decisions can be communicated to the healthcare team by means of an advance directive for healthcare.
 
The Self-Determination Act passed by the U.S. Congress in 1991 requires healthcare facilities to ask patients, at the time of admission, whether have executed an advance directive. It further requires them to provide information about advance directives and healthcare decision rights. A New Jersey law effective January 1992 states that written advance directives for people age 18 or over are legal and binding.
 
An advance directive is written documentation that may be used to tell others the care that you would like to receive or not receive in the event that you become incapacitated and cannot express your wishes yourself. It is an effective means of maintaining control over your care. It also can help relieve your family and loved ones of the burden of life-and-death decisions.
 
To download a booklet about advance directives that also contains a standard living will form, click on Advance Directives Booklet in the Related Documents box at right.

Terminology Associated with Advance Directives
Life-prolonging treatments may include artificial breathing, artificial feeding, surgical procedures, dialysis, efforts to restart the heart, medications other than those purely for comfort, and other treatments. You can specify in your advance directive/living will those treatments you wish to be performed or withheld, and under what conditions. Below are some terms you may encounter as you consider your advance directive wishes:
 
Antibiotics: Medications that combat serious infections anywhere in the body. Pneumonia is an example of a lung infection.
 
Artificial Feeding Tube/Artificial Nutrition & Hydration: A method of providing nutrition and fluids through a tube, for a patient who cannot eat or drink normally. Also called "feeding tubes" or "tube feeding."
 
Blood Products: A transfusion of blood products may be administered as a life-saving measure in a person who is anemic (low blood count) or bleeding.
 
Cardiopulmonary Resuscitation/Cardiac Resuscitation (CPR): An emergency procedure that restores and maintains breathing and circulation in a person whose heart or breathing has stopped. Carried out by performing chest compressions and assisted breathing.

Chemotherapy: Administration of drugs to fight cancer. The goal is to destroy malignant (cancerous or harmful) tumor cells without causing excessive or irreversible damage to the patient’s normal cells.

Comfort Measures: Pain medications, nursing care and treatments for the purpose of providing comfort and relieving pain.
Dialysis (Hemodialysis or Kidney Dialysis): Cleaning the blood by machine for patients whose kidneys have failed. Dialysis offers an artificial mechanism for performing some kidney functions.
 
Invasive Monitoring: Includes the use of complex monitoring devices to gather information in order to treat a seriously ill person. May include the insertion of a specialized catheter to monitor the heart. Invasive procedures are associated with some risk.
 
Intravenous/IV Fluids: A method of providing hydration and medications by way of a person’s veins. Usually used in a person who otherwise would not be able to receive fluids or medications.
 
Intravenous/IV Nutrition: Administration of specialized nutritional fluid by way of a person’s veins.
 
Lab Tests: Involves drawing blood and performing tests. Once tests are performed, abnormal values will be treated.

Mechanical Respiration/Breathing (Ventilator): Breathing with the help of a machine. A ventilator is also call a "respirator."

Resuscitation by Chemicals/Drugs: Use of chemicals/drugs to assist in restoring breathing and circulation in a person whose heart or breathing has stopped. May be used with or without CPR.

Living Wills & Durable Powers of Attorney for Healthcare

A living will is a form of advance directive. It states your wishes or instructions for healthcare in advance. It usually includes specific directions about life-prolonging treatments and the conditions under which you would or would not want such treatments carried out.
 
Also referred to as a proxy directive or designation, a durable power of attorney for healthcare is another form of advance directive. It appoints someone to make healthcare decisions in your best interest and according to your wishes, to the best of his/her ability.
 
You do not need an attorney or a physician to complete an advance directive. Your directive should be witnessed by two adults (if you choose to legally designate a person to make decisions for you, he or she cannot also be a witness). Give copies of the completed form to those who should know about your preferences, such as family members, friends and your doctor. If you enter a hospital, nursing home or other healthcare facility or residence, make sure your directive is made part of your medical records.
 
To download a copy of a standard living will form, click on Living Will in the Related Documents box at right.
    
What should I do with my completed Living Will?
You should discuss your decision with your close family and friends, and with your physician. It is important that your physician understands and agrees to carry out your wishes. Make sure a copy is placed in your medical file at the doctor’s office. You should keep the original in a place known to your family. You should give a copy to those people who may some day need to have it on your behalf. You should also give a copy to your clergy person and carry a card in your wallet stating that you have an advance directive. And you should bring a copy of your advance directive with you if you are hospitalized.
    
How often does my Living Will need to be updated?
Currently, there is no update requirement in the state of New Jersey. You should review it every year and initial and date it to show that it continues to express your wishes. You may make additions, changes or deletions at any time, as long as they are clearly initialed and dated. You can also, of course, revoke your advance directive at any time if you change your mind.
    
Where can I obtain a Living Will form?
To download a copy of a standard living will form, click on Living Will in the Related Documents box at right or call CentraState Medical Center’s Admitting Department at 732-294-2651.
    
CentraState Policy & Guidance
It is the policy of CentraState Medical Center to honor advance directives (except for directives prohibited by law). Our Bioethics Committee offers consultation services, without charge, to assist in resolving any problems that may arise. This committee offers periodic programs for the community related to advance directives and other bioethical issues.
 
If you need further information about advance directives, contact the Medical Center's QI/OM Department at 294-2835 between 8 a.m. and 5 p.m. weekdays, Saturdays between 7 a.m. and 3 p.m. and Sundays between 8 a.m. and 12 noon. We encourage every adult to consider completing an advance directive for healthcare while he/she is in good mental health, and able to consider these important options carefully and thoroughly.