Federal legislation (Patient Self-Determination Act, requires providers participating in the Medicare and Medicaid programs to furnish patients with information on advance directives. The information is to be given to patients upon admission to a facility or when provision of care begins. Providers covered by this requirement include the following entities: hospitals, nursing facilities, providers of home health or personal care services, hospice programs and health maintenance organizations.
Advance directives are legal forms that allow an individual to document his medical care preferences should he lose his medical decision-making capacity. Illinois law allows for the following three types of advance directives: (1) health care power of attorney; (2) living will; and (3) mental health treatment preference declaration. If you make one or more advance directives and/or a DNR order, tell your doctor and other health care providers and provide them with a copy.
Power of Attorney
A durable power of attorney for healthcare is a more comprehensive document that allows individuals to appoint a person to make healthcare decisions for them should they lose decision-making capacity. Anything written on this document can be rescinded at any time. The health care power of attorney lets you choose someone to make health care decisions for you in the future, if you are no longer able to make these decisions for yourself.
A living will is a document that allows an individual to indicate the interventions he or she would want performed if terminally ill, in a coma with no reasonable hope of regaining consciousness, or in a persistent vegetative state with no reasonable hope of regaining significant cognitive function.
A living will tells your doctor whether you want death-delaying procedures used if you have a terminal condition and are unable to state your wishes. A living will, unlike a health care power of attorney, only applies if you have a terminal condition.
Do Not Resuscitate
A DNR, Do Not Resuscitate, order can be given by the client or the family. This order can be rescinded at any time. You may also ask your doctor about a do-not-resuscitate order (DNR order). A DNR order is a medical order stating that cardiopulmonary resuscitation (CPR) will not be started if your heart or breathing stops. You may sign a document directing that should your heart or breathing stop, efforts to resuscitate you will not be started. Your attending physician may also sign a DNR order.
Before a DNR order may be entered into your medical record, either you or another person (your legal guardian, health care power of attorney or surrogate decision maker) must consent to the DNR order. This consent must be witnessed by two people who are 18 years or older. If a DNR order is entered into your medical record, appropriate medical treatment other than CPR will be given to you.
Bereavement and Children
Healthcare providers should reassure their dying young patients that their feelings are accepted. They should offer love, physical closeness, and physical comfort. Providers should be sensitive to nuances in the child-s behavior regarding when and how much to communicate about their prognosis. Providers need to talk with children about death in an honest, specific way and give children an opportunity to make decisions about care whenever possible. These strategies are particularly important when the patient is an adolescent.
Grief is a global experience. Death is a great loss in any culture. Families experience this loss within the context of personal beliefs, values, and experiences. We, as health caregivers, assume a position to assist the family in helping them to prepare to make future health care decisions now.
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