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C Cho oic ces
Liiving g Well W at a th he E End d of Life e
Advance Directiv D es Pack ket Sixth h Edition
The Midw west Care Alliance A expresses dee ep appreciattion and grratitude for tthe coopera ation of the Ohio State Me edical Assoc ciation, the Ohio Hosp pital Association and th he Ohio hic Associa ation for their efforts in the develo opment and distribution n of this Advvance Osteopath Directives s Packet: Choices, Liviing Well at the End of Life. We allso thank th he Ohio Sta ate Bar Associatio on for provid ding the leg gal languag ge for the L iving Will and Health C Care Power of Attorney forms. f The packet includes inform mation rega arding Hosp pice and Do o-Not-Resuscitate Orders, a Donor Reg gistry Enrolllment Form m and one ccopy each o of Ohio’s Livving Will an nd Health Ca are Power of o Attorney forms. The Living Will and Health h Care Pow wer of Attorn ney forms con nform with the requirem ments of Oh hio’s Advan nce Directivve laws, as amended effective March M 2014 4.
Midwes st Care Allliance 2233 N North Bank Drive Columb bus, Ohio 4 43220 www.m midwestcare ealliance.orrg
Ohio S State Medic cal Associa ation 3401 M Mill Run Drivve Hilliard , Ohio 4302 26 www.ossma.org
Ohio H Hospital As ssociation 155 Ea ast Broad Street Columb bus, Ohio 4 43215-3620 0 www.oh hanet.org
Ohio O Osteopathic c Associattion 53 Wesst Third Ave enue PO Boxx 8130 Columb bus, Ohio 4 43201-0130 0 www.oo oanet.org
Table T e of Cont C tentss Introducction ......................................................................................................... 2 Your Qu uestions Answered A d .................................................................................. 3 Ohio’s Health H Caare Powerr of Attorrney: Whaat You Shhould Knnow .................. 5 Ohio’s Guardians G ship: Defi finitions and a FAQss..................................................... 9 State of Ohio Health Care Power of Attorneey Form ....................................... 11 L Will: W What You Sho ould Know w ................................................. 23 Ohio’s Living State of Ohio Liv ving Will Declaratiion Form ................................................... 27 m ................................................................. 35 State of Ohio Donor Regisstry Form D Resuscitatte Laws ..................................................................... 39 Ohio’s Do-Not-R The Hosspice Cho oice ......................................................................................... 42
In ntrod ducttion
T Today, advances in medicine and meedical ttechnology save s many lives that only y 60 years aago might haave been lost. Unfortunaately, ssometimes th his same tech hnology also o aartificially prrolongs life for people who w have nno reasonablle hope of reecovery. D Death and dy ying are inesscapable realities of life. A Armed with the informattion and form ms in this ppacket, the goal g is to pro ovide you wiith the iinformation you need to document your y future hhealth care decisions d and d take contro ol of many cchoices regaarding your medical m futurre. IIt is importan nt to understtand what Ohio’s laws aallow or do not n allow in regards to expressing yyour desires,, goals and wishes w by ussing tools ssuch as Ohio o’s Advance Directives. This packet iis meant to educate e you about Ohio’s Living W Will; Health h Care Powerr of Attorney y; A Anatomical Gifts; and Do D Not Resusscitate laws. IIn 1991, Ohiio recognized your right to have a L Living Will. Ohio’s otheer recognized d advance ddirective at that t time wass the Health Care P Power of Atttorney. In 19 998, Ohio reecognized yyet another tool t to help you y and yourr physician w with effectiv ve health care planning called c a D DNR (Do-N Not-Resuscitaate) Order. T The Living Will W allows you y to decid de and ddocument, in n advance, th he type of caare you w would like to o receive if you y were to become ppermanently y unconsciou us or terminaally ill and uunable to com mmunicate. The Health Care P Power of Atttorney enablles you to seelect ssomeone to make m decisio ons for you.
A peerson who ddoes not wishh to have Carddiopulmonarry Resuscitaation (CPR) perfformed may make this w wish known throough a doctoor’s order callled a DNR O Order. AD DNR Order aaddresses thee various meethods usedd to revive ppeople whosee hearts havee stoppped (cardiacc arrest) or ppeople who hhave stoppped breathinng (respiratoory arrest). T This phy sician order allows emerrgency mediical worrkers and heaalth care prooviders to hoonor indiividual wishees about resuuscitation innside or ooutside a hosspital, nursinng home, hom me or variious other seettings. In coontrast, if yoou choose, yyou can fill oout the Liviing Will or H Health Care Power of Atttorney form ms without thhe assistancee of a lawyerr. How wever, since tthese are impportant legal docuuments, youu may wish too consult a lawyer for aadvice. In adddition to thhe Living Wiill and Healtth Care Pow wer of Attornney forms, yoou will find a copy of thhe Donor Reegistry Enrolllment Form m in this packket. Also included in this packet is info rmation on hhospice caree and end of life issuees and optioons. The last page offers a convvenient walllet card that w will providee impoortant inform mation to yoour health carre provvider. The elements innvolved in drrafting or deteermining onee’s wishes reegarding Advvance Direectives are very importannt. After revieewing the coontents of thhis packet, yoou mayy have additiional questioons or concerrns speccific to your personal situuation. In suuch casee, it may be iimportant thhat you discuuss yourr decisions w with your fam mily, your cllergy, yourr physician aand/or your llawyer.
Your Qu uestio ons were ed Answ “Living Willl and Hea alth Care P Power of Attorney”
Q Q: Who sho ould compleete a Living Will or Health Care C Power of o Attorney y?
hich is betteer to have, a Living Willl or Q: Wh aH Health Care Power of A Attorney?
A A: Serious illlness or inju ury can strik ke at any stag ge of life, so it is importaant for anyon ne over age eighteen to t think abou ut filling out these documentts. A Living Will or Health Care Power of Attorney will help to ensure that you ur wishes reg garding life--sustaining trreatment aree followed regardless r off your age.
A: It iss a good ideaa to fill out bboth documeents beccause they adddress differrent aspects oof your meddical care. A Living Willl applies only when youu are terminaally ill and uunable to com mmunicate yyour healthcaare wishes orr are perm manently unnconscious. IIn both casess, if you havve indicated tthat you do nnot want youur dyinng to be artiificially proloonged and tw wo phyysicians deteermine that thhere is no reassonable hopee of recoveryy, your wishhes will be hhonored.
Q Q: Can I in ndicate thatt I wish to donate my y organs after a death through t a Living L Willl or Health h Care Pow wer of Attorn ney? A A: Within th his brochure are instructio ons and a standardizzed form to register r yourr wishes regarding g organ and tissue t donation with the Bureau off Motor Veh hicles. This is the most appropriaate way to do ocument you ur wishes if you want to be a dono or. This form m should be filed with h the Bureau of Motor Veehicles. Q Q: If I statee in my Livin ng Will thatt I don’t want to be b hooked up u to life sup pport equipment, will I stiill be given medication for pain? ? A A: Yes. A Liiving Will afffects only care c that artificially y or technolo ogically posttpones death h. It does no ot affect caree that eases pain. p You would con ntinue to be given pain medication m and other treatments necessary n to keep you comfortab ble. The sam me is true witth a Health Care Pow wer of Attorn ney. The persson you nam me to make your y health care c decision ns may not refuse treatments thatt alleviate paain.
AH Health Care P Power of Atttorney becom mes effeective even if you are onnly temporariily uncconscious and medical deecisions need to be madde. For exam mple, if you w were to becoome tem mporarily uncconscious duue to an accident or surggery, the perrson you nam me in your H Health Carre Power of A Attorney couuld make meedical deciisions on yoour behalf. If yyou have bothh documentss and becom me term minally ill annd unable to communicaate or becoome permannently unconnscious, the L Living Willl would be ffollowed sinnce it identifiies your wishhes in these situations. Q: Caan I draft a L Living Will or Health C Care Poower of Attoorney that saays if I becoome criitically ill, I want everyything possib ble done to keep me aliive? A: Yess, but you would need too speak with an attoorney about ddrafting a doocument exppressing thosse wishes raather than usiing the standdard form ms in this paacket. You shhould also ddiscuss youur wishes witth your personal physiciian. 3
Q Q: If I namee someone in n my Health Care Power of Attorney to make decisiions for me, how much m authorrity does tha at person have? A A: The person n you name as a your attorn ney-infact has th he authority to make decissions regarding aspects of yo our medical care c if you become un nable to exprress your wisshes. For this reason n, you should d tell the persson you name how w you feel abo out life-sustaaining treatment, being fed th hrough feedin ng or fluid tubes, and d other imporrtant issues. Also, it is important to o remember th hat a Health Care Poweer of Attorneey document is not the same as a Financial Po ower of Attorrney m use to give document, which you might a oveer your financcial or someone authority business affairs a . Q Q: If my con ndition becom mes hopeless, can I specify th hat I want my feeding an nd fluid tubes rem moved? A A: Special instructions aree needed to allow a for the removal of feeding or fluid tubes iff you becomee permanenttly unconscio ous and if thee feeding and d fluid tubess aren’t needed to providee you with comfort. If you want to o make certaiin that the tubes are removed r should you beco ome permanenttly unconscio ous, you need d to place your initiaals on the spaace provided on the Living Will or Heealth Care Po ower of Attorrney form. Iff you don’t want the tub bes removed when w you aree permanenttly unconscio ous, don’t iniitial the forms. Q Q: If I want to complete a Health Ca are Power of Attorney, do I also o have to nom minate a Guardian of my Perso on and Estatte? A A: In 2014, th he Ohio Heallth Care Pow wer of Attorney was w expanded to allow yo ou to nominate a guardian to o your person n and a guardian to t your estatee. In Ohio, gu uardianship is typically y pursued wh hen a person becomes incompeteent, such as with w advanced d dementia, and there is i no family member or significant other williing to undertake the respo onsibility to
advvocate for thaat person. In ssome cases, guaardianship maay also be puursued if there is connflict betweenn responsiblee family mem mbers. By nnominating a guardian inn the Health C Care Pow wer of Attornney, you wouuld communiccate youur preferencess to the probaate court to cconsider youur preferencess, should a guuardianship pprocess everr begin. How wever, you arre not requireed to com mplete this seection if you ddo not wish tto. If youu prefer not too nominate a guardian, sim mply draw w a large "X"" over this secction of the fform. Q: Do I have to usse the standaard forms foor a Liiving Will or Health Caare Power off Attoorney or can n I draw up my own doccuments? A: Thee enclosed foorms were prroduced jointtly by thee Ohio State B Bar Associattion, the Ohioo State Meedical Associiation, the Ohhio Hospital Asssociation, Ohhio Osteopathhic Associatiion andd the Midwesst Care Alliannce. They coomply witth the requireements of Ohhio law, but yyou do nott have to use these forms.. You may w wish to connsult an attorrney for assisstance in draffting a doccument or yoou may draft your own. Inn either casse, the docum ments must coomply with thhe speecific languagge spelled ouut in the Ohioo Revvised Code. n I use Advaance Directivve or DNR oorders Q: Can froom states forr healthcare decisions in n Ohio? A: Addvance directiives and heallth care decission form ms vary from m state to statee. For exampple, some statees may recoggnize Five W Wishes (ww ww.fivewishees.org) or a P POLST form (Phyysician's Ordders for Life--Sustaining Treaatment/www w.polst.org). U Under Ohio llaw, heallth care provviders should attempt to hhonor any advvance directivve presented to them. How wever, it is sttrongly recom mmended thaat if you spennd any reguular amount oof time in Ohhio, that you com mplete Ohio'ss advance dirrectives in accordance withh Ohio law.
Ohio o’s Hea alth C Care e Pow wer o of Atttorne ey
W What yo ou should know w about a Health h Care P Power oof A Attorneey: A Health Care C Power of Attorney y is a docum ment that alloows you to name a persson to act onn your bbehalf to maake health caare decision ns for you if you becomee unable to m make them for yourselff. This p person beco omes an atto orney-in-facct for you. T The Health Care Powerr of Attorney also allow ws you to noominate a guuardian to yyour person and a gguardian of your estate. Nomination n does not guarantee g thhat this indivvidual will bbe appointedd to be yyour guardiaan. Instead, it provides an opportu unity for inddividuals to express theeir preferencces for gguardianship p which can be taken intto account sh hould the isssue ever be bbrought to prrobate court.. IIf you have a Health Care Power of Attorney y and a Livin ng Will, heaalth care woorkers must ffollow tthe wishes you y state in your Living g Will, oncee the Livingg Will becom mes effectivve. In other w words, yyour Living Will takes precedence p over o your Heealth Care P Power of Atttorney. Y You can chaange your miind and revo oke your Hea alth Care P ower of Atttorney at anyy time. You can ddo this simply by telling g your attorney-in-fact, your y physiciaan and your family that yyou have cchanged you ur mind and wish to revo oke your Hea alth Care P Power of Atttorney. In thhis case, it iss a ggood idea to o ask for a co opy of the do ocument bacck from anyoone to whom m you may haave given it. A Healthcarre Power of Attorney A is different d from m a Financiaal Power of A Attorney thaat you use too give ssomeone autthority over your financiial matters. T The person you y appoint as your atto orney-in-facct, by compleeting the Heealth Care P Power of A Attorney fo orm, has the power p to autthorize and refuse r mediccal treatmentt for you. Th his authoritty is rrecognized in all mediccal situation ns when you u are unablee to express your own w wishes. Unlikke a L Living Will, it is not lim mited to situaations in whiich you are tterminally ill or permaneently unconsscious. F For examplee, your physiician or the hospital h may y consult witth your attorrney-in-fact sshould you bbe iinjured in a car c accident and becomee temporarily y unconsciouus. You mayy also choose to allow pprotected heealth care infformation to be shared with w your attoorney-in-facct immediately, by initialling tthe appropriate box in th he documentt.
T There are fiv ve limitation ns on the autthority of yo our attorney--in-fact: 1. An attorney-ina fact has lim mited authorrity to orderr that life-su ustaining treatment be withdrawn from m you. Your attorney-in--fact may ordder that life--sustaining ttreatment be refussed or withdrrawn only iff you have a terminal conndition or iff you are in a permanentlly unco onscious statee. And even then, the atttending physsician and, iff applicable,, the consulting physician, must confirm c thatt diagnosis, and a your atteending physiician(s) musst determine that you have h no reassonable possibility of reg gaining decission-makingg ability. 2. Yourr attorney-iin-fact does not have th he authorityy to order th he withdraw wal of “comffort care.” Comfort care c is any ty ype of mediccal or nursinng care that w would providde you with comffort or relieff from pain. 3. If yo ou are pregn nant, your attorney-ina fact cannot order the w withdrawal of life-sustaaining treattment unlesss certain co onditions are met. Life--sustaining trreatment cannnot be withdrawn if doing so would d terminate the t pregnanccy unless theere is substanntial risk to your life or ttwo physicians determ mine that thee fetus would d not be borrn alive. 4. Yourr attorney-iin-fact may order that nutrition n an nd hydratioon be withdrrawn only iff you are in i a termina al condition or permanently uncon nscious statee and two physicians aggree that nutrition an nd hydratio on will no lo onger provid de comfort oor alleviate pain. If youu wantt to give you ur attorney-in n-fact the autthority to wiithhold nutriition and hyddration if yoou weree to become permanently p y unconsciou us, you mustt indicate thiis in the apprropriate secttion of the Health Ca are Power of o Attorney form. If youu also have a Living Willl, it should bbe y Health Care Powerr of Attorneey regardingg the withhollding of nutrrition consistent with your h In n other word ds, if you ind dicate in yourr Health Caare Power oof Attorney tthat and hydration. it is permissible p for f your atto orney-in-factt to order thaat nutrition aand hydrationn be withhelld, then you also sho ould indicatee in your Liv ving Will th at it is permissible for yoour physiciaan to withh hold nutritio on and hydraation.
5. If yo ou previouslly have giveen consent fo or treatmen nt (before beecoming un nable to comm municate), your y attorn ney-in-fact cannot c withd draw your cconsent unleess certain cond ditions are met. m Either your y physicaal condition m must have chhanged and/or the treatm ment you approved a is no longer off benefit or th he treatmentt has not beeen proven efffective.
H How to fill out the t Hea alth Care Powerr of Attoorney foorm: Y You should use this form m to appoint someone to o make healthh care decisiions for you if you shoulld bbecome unab ble to make them for you urself. N NOTE: The section titleed NOTICE TO ADULT T EXECUTIN NG THIS D DOCUMENT T is requiredd by law tto be part off the documeent and mustt accompany y it and any ccopies distribbuted. 1. Read overr all informaation carefullly. You may y reference the definitioons found onn pages one and two of the tweelve page State of Ohio o Health Caare Power off Attorney fform locatedd in this boooklet for further claarification. 22. On the firrst two lines of the form, print your full f name andd birth date. 33. Under, “N Naming of My M Agent,” fill fi in the nam me of the perrson you aree appointing as your attoorneyiin-fact, the agent’s a curreent address and a telephon ne number. Im mmediately following, yyou may inittial the bbox if you wish w for yourr agent to im mmediately have h access tto your proteected health care informaation ((PHI). If you u choose nott to initial this box, your agent will oonly have access to yourr protected health ccare informaation in the event e that yo ou are incapaacitated and the Health C Care Power oof Attorney is aactivated. 44. In the mid ddle of the th hird page, yo ou may namee alternate aagents on thee indicated sppaces; if youu cchoose not to name alterrnate agents,, you should cross out thhe unused linnes. You mayy not name yyour aattending ph hysician or th he administrator of any nursing n hom me where youu are receivinng care as yoour aattorney-in-ffact. 55. On page five f of the Health H Care Power P of Atttorney form, written in bbold face typpe under Speecial IInstructionss, is the stateement that will w give yourr physician ppermission too withhold ffood and watter in tthe event you are perman nently uncon nscious. If you y want to ggive your phhysician perm mission to w withhold ffood and waater in this situation, then n you must place p your innitials in the box indicateed. 66. On page five f at the bo ottom, the fo orm providess a section w where you maay write addditional instruuctions aand impose additional limitations that you may consider c apppropriate to ddocument. Y You may attaach aadditional paages if needeed. You shou uld include all a attached ppages with aany copy(iess) you make and yyou should note n the attacched pages on o the form itself i in the rrelated area.. 77. On page six, s there is an a explanatio on of the nom mination of guardianshipp. If you wissh to nominaate the ssame individ dual whom you y named as a agent to allso serve as yyour guardiaan of personn, place your initials iin the indicaated box and cross out th he unused lin nes. If you w wish to nominnate a differeent individual to sserve as guaardian of you ur person, wrrite the namee, address annd relationshhip to you onn the line inddicated.
8. On page seven, s you may m nominate an individu ual to serve as guardian of your estaate. If you wiish to nnominate the same indiv vidual whom m you named d as agent to also serve aas your guarddian of estatee, pplace your in nitials in thee indicated box and crosss out the unuused lines. Iff you wish too nominate a different ind dividual to seerve as guard dian of yourr estate, writee the name, address and relationshipp to yyou on the line indicated d. Below, pleease indicatee whether yoou would preefer the indivvidual nominated tto serve as guardian g of your y estate be b bonded, orr if you wouuld prefer anyy bond be w waived by plaacing yyour initials in the appro opriate box. 9. Following g the nominaation of guarrdians is a seection wheree you indicatte whether orr not you havve a Living Willl. 10. On page eight, there are spaces to t date and sign the form m. Remembeer, the Health h Care Pow wer of Attorney y is not conssidered valid d or effectivee unless youu do one of thhe followingg: First Optio on (Page 9) – Date and sign s the Heaalth Care Poower of Attoorney in the presence off two witnessses, who also o must sign aand include their addresses and indicate the date of their t signatu ures. OR Second Option (Page 9)– 9 Date and d sign the Heealth Care P Power of Atttorney in thhe presence off a notary pub blic and hav ve the Health h Care Pow wer of Attorn ney notarizeed on the appropriiate space prrovided on th he form. The followin ng people may m not servee as a witnesss to your Heealth Care P Power of Atttorney: x x x x x x
Primary agent; a Guardian n of your Perrson or Esta ate; Alternatee or successo or agent or guardian; g Anyone related r to you u by blood, marriage, m orr adoption (yyour spouse and childrenn); Your atteending physiccian; The admiinistrator off nursing hom me where youu are receivving care.]
Ohio’ O s Guard G dianship D DEFINITIO ONS P Principal: (aalso known as a Declarantt) is the Com mpetent Adullt who comppletes any addvance directive like a Power of Attorney, A a Health H Care Power P of Atttorney, Liviing Will or oother documeent. A Agent: (also o known as Attorney A in fact) f is the peerson that thhe Principal nnames in thee advanced ddirective. G Guardian: is the person that the Pro obate Court names n to actt for the Supeerior Guardiian which is the ccourt. The person p serves at the direcction of the Probate P Couurt and is ansswerable to tthat Court. N NAMING VS V NOMINA ATING T There are many differen nces between n a Principal naming an Agent to actt for him/herr if necessarry and a P Principal no ominating an n individual to be his/herr guardian. N Naming an Agent A throu ugh an advan nce directive,, such as a P Power of Attoorney, Healtth Care Pow wer of A Attorney or a Living Wiill, is compleeted by a Priincipal who iis a COMPE ETENT ADU ULT. Comppleting tthis naming occurs beforre the need arises a for thee Agent to acct and is donne solely at tthe discretionn and ddesire of thee Principal. The T Agent usually u takess over decisioon making w when the Prinncipal becom mes iincapable off making deccisions. N Nominating g a person to o become thee guardian off the person,, the estate oor both is alsoo completedd by a P Principal wh ho is a competent adult. This occurss through an advance dirrective beforre the need aarises for a guardian. However, nominating a person to beecome guarddian if one iss needed doees not autom matically m mean the nominated person will beccome the guaardian. T The actual naming n of a guardian of the person, the estate orr both is donne solely by a Probate Coourt in O Ohio after th he Principal becomes inccompetent. Nominating N g a person too become thee guardian inn any aadvance direective is the means by which w the Prin ncipal comm municates to the Probate Court whom m the P Principal wishes to be ap ppointed by the Court ass guardian. N Nominating a person to become the gguardian doees not insuree that the Court will nam me that perso n. There aree numerous factors whicch the ccourt must examine e in making m its deecision and it is totally up to the courrt who it nam mes as guarddian. T To begin thee process of seeking a gu uardianship, the nominatted person m must first maake a written aapplication to t the Court to become th he guardian.. The Court will make thhree (3) decisions: 1. Is thee Principal leegally incom mpetent; 2. Is it necessary n th hat a guardian nship be estaablished in pplace of any other writteen document such as a Health Care Po ower of Attorney; and d competentt person whoom the courtt desired to nname as guarrdian? 3. Is thee applicant a suitable and
F FREQUENT TLY ASKED D QUESTIO ONS Q Q: What is the t differencce between an a Agent and d a guardian n? A A: An agent is named by the competeent Principal and a has no ooversight by aany other perrson or agenccy once tthe Principal becomes inccapable of making decisio ons. A guarddian is namedd by the Probbate Court affter it ddetermines th hat the princiipal is incom mpetent and th he Court provvides oversigght as the Couurt is the supperior gguardian. Q Q: I have alw ways heard that if I nam me someone to be my Aggent, there w will not ever be a need foor a gguardianshiip to be estab blished through the court. A A: One of thee reasons to name n an Ageent in an Adv vance Directiive is the dessire to avoid gguardianshipp. H However, an ny number off reasons coulld arise whicch force the nneed for a guaardianship. O One examplee: the P Principal beccomes incom mpetent, thus precluding p naming someoone other thaan the personn acting as Aggent. A ffriend of the Principal fin nds out that th he Agent is taaking advanttage of the Prrincipal. Thee only way too obtain a different peerson to act for f the incom mpetent Princiipal is to appply for guardiianship throuugh the Courtt so that tthe court can n provide oveersight. Q Q: Are theree different kinds k of guarrdianships? A A: Dependin ng on the need ds of the Prin ncipal, there may be the nnecessity to nname a guarddian of the peerson, tthe estate, orr both. A guaardian of the person makees decisions cconcerning suuch items as where to livve, health ccare, end of life, l and so fo orth. A guarrdian of the estate makes ddecisions on how to spennd the princippal's m money within n the directio ons from the Court. If yo ou are unsure what type off guardianshiip is necessarry, you aare advised to obtain legaal advice. Q Q: What if different d peo ople are nom minated to bee the guardiian in differeent documen nts? A A: The princcipal may cho oose to nomin nate different people to bbe guardian of the estate aand guardian of the pperson. The preference of o the Court is to name on ne person to aact as guardiaan of both buut there can bbe solid rreasons for different d peop ple to act in different d capaacities. On thhe other handd, if the nom minating of a gguardian iis inadverten nt and two people are nom minated in thee same capaccity, both will have to makke an applicaation to tthe Court, an nd the Court will w decide which w of the two t to choose. The Courrt may also chhoose a thirdd aapplicant, no ot even named d by the prin ncipal. It is so olely within the discretionn of the Couurt. This is w why it is ccritical to maake sure that all of your ad dvance direcctives, such aas a General D Durable Pow wer of Attorneey, a H Healthcare Power P of Atto orney, a Livin ng Will, and any other wrritten document which naames someonne to sserve in the future, f are co oordinated an nd done with full planningg. Because oof the criticall need to coorrdinate nnominations of agents and guardians, it is advisablle to work w with an attorneey for this coonsistency, Q Q: What if the t Court na ames a differrent guardia an than the P Principal sellected as an Agent throu ugh one oof the writteen advance directives? d A A: During th he process of the court’s naming n a guaardian, all wriitten advancee directive doocuments muust be ggiven to the court c to exam mine. At the time of the hearing, h the C Court will deetermine whaat the powers of the gguardian are and what if any a decisions will belong g to the Agennt. If there is ever a disaggreement betw ween the gguardian and d the Agent, the t Court, as the superior guardian, wiill determinee the decisionn to be made.. If there iis a conflict at a any time during d the app plication proccess, it is advvisable to seeek legal counnsel. n Q Q: What happens if I na ame an agen nt or nomina ate a person I desire to b be my guard dian and then cchange my mind? m A A: A Princip pal can chang ge his/her min nd whom to name n as the aagent or guarrdian at any ttime as long as the aadult is comp petent. The Principal P may y revoke any y document aand rename/ree-nominate ddifferent peopple as llong as the Principal P is co ompetent. On nce the Princcipal becomees incapable oof making deecisions abouut his/her pperson or esttate, that persson cannot ch hange any ad dvance directiive. Q Q: Are theree minimumss or maximu ums required d for a guard dianship of the Estate? A A: This is a complex c issu ue that should d be discusseed with legal counsel.
Ohio o’s Livin ng W Will What You Y Shou uld Kno ow Abou ut Livin ng Wills A Living Will W is a docu ument that alllows you to establish, inn advance, thhe type of m medical care yyou w would want to receive iff you were to o become peermanently uunconscious,, or if you w were to becom me tterminally illl and unablee to tell yourr physician or o family whhat kind of life-sustainingg treatmentss you w want to receeive. In addittion, the lateest edition off the Living Will allows you to speccify your wisshes rregarding an natomical giffts (organ an nd tissue don nation). A Living g Will is used only in situ uations where you are un unable to tell your physiccian what kind of health care seervices you want w to receiive. Before yyour Living Will goes innto effect, you eitheer must be: (1) Terminally ill (see definition as described d in the Livin ng Will Decclaration Forrm) and unable to o tell your ph hysician yourr wishes reg garding healtth-care services; OR (2) Permaanently unco onscious. To o be considerred permaneently unconsccious, two pphysicians (oone of whom mu ust be a med dical specialiist in an apprropriate fieldd) must deciide that you have no reasonablle possibility y of regainin ng conscioussness. R Regardless of o your cond dition, if you u were able to o speak and tell your phyysician yourr wishes aboout llife-prolongiing treatmen nts, then the Living Will wouldn’t bee used – youur physician w would just taalk ddirectly with h you about your y wishes. A Living Will W is used bby the physician only if you are unabble to ttell him or her h what you want to be done. d A Living g Will may give g your ph hysician thee authority tto withhold all life-sustaaining treatm ment and perm mit you to diee naturally and a take no action to poostpone youur death, prooviding you with only that care necessary to mak ke you com mfortable andd relieve yoour pain. Thhis may incclude writing a DNR Ord der or with hdrawing liffe-sustainingg treatment such as ccardiopulmonary resuscitattion (CPR). Such “comfort care” also a may incclude removving nutrition and hydraation (food and d water) that is administeered through h feeding tubbes or intravvenously. If yyou wish to give your physician this authority a if you y becomee permanentlly unconscioous, there iss a space onn the Living Will W form thaat you mustt initial. If you y want nuutrition and hydration tto be continnued, regardlesss of the circu umstances, don’t d initial this t space.
A Living Will can be honored only if your atttending physsician and otthers know aabout it. It iss nd your famiily and friennds know thaat you have a Living Willl importantt to let your physician an before yo ou become ill. It is a good idea for yo ou to give yoour attendingg physician a copy of yoour Living Will. W It also iss important to t give copiees to family aand friends sso that, if neecessary, theyy can advise yo our physician n that you haave a Living Will. In adddition, it is im mportant thaat you notifyy a health carre facility that you have a Living Wiill when youu are admitteed as a patiennt. Please noote: You do not n have to go o to court to put your Living Will innto effect. If a decisiion is made to withhold or withdraw w life-sustainning treatmennt, your phyysician must make a reasonablle effort to notify n the perrson or perso ons you desiignate in youur Living Wiill or your cllosest family meember. The law allows your family mem mbers to chaallenge a phyysician’s deetermination that you haave a terminal illness i or that you are in n a permaneently unconsscious state. This challennge is limiteed in nature an nd may be made m only by y your closesst relatives. The law doees not, howeever, allow yyour family meembers to ch hallenge you ur own legallly-documentted decision not to be resuscitated. If you hav ve both a Liv ving Will an nd a Health Care C Power oof Attorney,, the physiciaan must com mply with the wishes w you state s in your Living Willl. In other woords, your L Living Will takes precedeence over yourr Health Care Power of Attorney. A On n page four oof the Livingg Will form,, there is a sppace that you may m check to o let your ph hysician and family and ffriends know w that you have a Healthh Care Power off Attorney. You can revoke r your Living Willl at any time. You can doo this by sim mply telling yyour physiciian and family thaat you have changed you ur mind and wish to revooke your Livving Will. It is a good iddea to ask anyon ne who has a copy of thee document to t return it too you.
How to Fill Out the Liv ving Wiill Form m Y You should use this forrm to let you ur physician and your faamily know what kind oof life-sustainning ttreatments you y want to receive if you y become terminally iill or permaanently uncoonscious andd are uunable to ex xpress your wishes. w 1. Read over all info ormation caarefully. Im mportant deffinitions aree included in the doocument. 2. On the firrst two lines on page 2 of the form, print p your fuull name and birth date. 3. On page 4, you may indicate wh hether you have h compleeted a Healthh Care Pow wer of Attornney. The next sectiion of the fo orm providess space for you y to list thhe names, aaddresses andd phone num mbers of the contaccts (usually family mem mbers and clo ose friends) tthat you wannt your physsician to notiify when the decisiion is made to t withhold or o withdraw life-sustainiing treatmennt. 44. On page 5 of the fo orm is a bo ox next to the t boldfacee section w which will give your phhysician permissio on to withhold food and fluids in thee event you are permannently unconnscious. If yoou want to give yo our physician n permission n to withhold food and w water in thiss situation, thhen you must place your initiaals in this bo ox.
5. On page 6 of the form m is a place for f you to daate and sign tthe form. Reemember, th he Living W Will is not consideered valid orr effective unless u you do one of thee following: Firrst Option – Date and siign the Livin ng Will in thhe presence of two witneesses, who aalso mu ust sign and include theirr addresses and a indicate the date of ttheir signatuures. The followin ng people may m not servee as a witnesss to your Liiving Will: • Prim mary agent in n the declara ant’s Health Care Powerr of Attorneyy; • The nominated n guardian g of the t declarant’s person orr estate; • Alterrnate or succcessor agentt in the decla arant’s Heallth Care Pow wer of Attornney; • Anyo one related to the declarant by blood d, marriage oor adoption (the declaraant’s spouse and child dren); • The declarant’s d attending a ph hysician; • The administrato a or of the nurssing home where w the decclarant is reeceiving caree. OR O Second Option n – Date and d sign the Liiving Will inn the presencce of a notarry public andd have thee Living Will notarized on the appro opriate spacee provided on the form. 6. Once you u have filled out the Living Will and d either signeed it in the ppresence of w witnesses or in the ppresence of a notary pub blic, then it is i a good ideea to give a ccopy to yourr personal phhysician and any contacts you u have listed d in the Livin ng Will. In some s Ohio coounties, peoople may be aable to regisster ttheir Living g Wills with the county recorder. r However, it is iimportant too keep in minnd that a rregistered Living L Will form f becomees a public reecord.
DONOR REGISTRY ENROLLMENT OPTIONS OPTION 1 Upon my death, I make an anatomical gift of my organs, tissues, and eyes for any purpose authorized by law. OPTION 2 Upon my death, I make an anatomical gift of the following organs, tissues, and/or eyes selected below: All organs, tissues and eyes ORGANS
Liver (and associated vessels)
Kidneys (and associated vessels)
For the following purposes authorized by law: All purposes
OPTION 3 Please take me out of the Ohio Donor Registry. SIGNATURE OF DONOR REGISTRANT
Ohio’ O s Do o-No ot-Re esusscitate W What You Y Shou uld Kno ow Abou ut Do-Noot-Resu uscitate ((DNR) L Laws in n Ohio O Ohio’s Do-N Not-Resuscittate (DNR) Law L gives in ndividuals thhe opportunitty to exercisse their rightt to llimit care received in em mergency situ uations in sp pecial circum mstances. “Sppecial circum mstances” iinclude care received fro om emergency personnel when 911 iis dialed. Thhe law authoorizes a physician to w write an ord der letting heealth care peersonnel know that a pattient does noot wish to bee resuscitatedd in the eevent of a cardiac c arrest (no palpab ble pulse) orr respiratoryy arrest (no sspontaneous respirationss or the ppresence of labored breaathing). T The followin ng information is includeed as a brieff overview o f some of thhe more com mmon questioons, iissues and co oncerns regaarding Ohio’’s Do-Not-R Resuscitate laaw. It is not m meant to proovide all iinformation needed to make m the deciision to havee a Do-Not-R Resuscitate oorder writtenn. An individdual m may have a DNR D order written w afterr consultatio on with his oor her physiccian regardinng end-of-liffe iissues. T The DNR orrder may be honored in multiple m setttings, includiing but not llimited to: nuursing facilitties, rresidential care facilitiess, hospitals, outpatient o arreas, home, aand public pplaces. For a DNR order to be uuseful in mu ultiple setting gs, it must bee recognizab ble by healthh care workeers. The Ohioo Departmennt of H Health has developed d a standard s ord der form thatt is generallyy recognizedd. You may cchoose to dissplay tthe form in your y residen nce to be easiily visible to o healthcare ppersonnel annd transport it with you w when yyou are away y from homee. Other DN NR identificattions, includding a wallett identificatioon card, mayy be uused but mu ust include th he Ohio DNR R logo to be valid. U Unlike a Liv ving Will and d Health Carre Power of Attorney whhich can be eexecuted witthout the inpput of a hhealthcare professional, a DNR Ordeer must be written w and s igned by a pphysician, ann advanced-ppractice nnurse, certifi fied nurse praactitioner or physician assistant afterr consultatioon with the ppatient. D DNR order on the state approved document d is legally-sancctioned and iimplementedd according to Ohio L Law. The DN NR order is implementeed at differen nt points, deppending upoon the patiennt’s wishes aand must bbe consisten nt with reason nable medical standards. C Care that easses pain and d suffering will w always bee implementted regardlesss of a DNR R order. Otheer rrelated care will be prov vided depend ding on the specific s ordeer that your pphysician preescribes. Yoour sshould check k with your prescriber p reegarding the right type oof DNR ordeer needed whhen considerring yyour specificc medical neeeds.
DNR/CPR Care: The Facts Ohio first adopted a law concerning DNR orders in 1998. DNR stands for “do not resuscitate.” A person who does not wish to have cardiopulmonary resuscitation (CPR) performed may make this wish known through a physician’s order called a DNR order. A DNR order addresses the various methods used to revive people whose hearts have stopped functioning or who have stopped breathing. Cardiopulmonary Resuscitation (CPR) has a broad meaning. It includes any or all of the following: Administration of chest compressions; Insertion of an artificial airway; Administration of resuscitation drugs; Defibrillation or cardioversion; Provision of respiratory assistance; Initiation of a resuscitative intravenous line; or Initiation of cardiac monitoring. CPR can be life-saving but some people may not want it administered in certain cases. In some cases, CPR saves lives. In many cases, it is not effective. Many people overestimate the success of CPR. A person who is revived may be left with permanent or painful injury. Resuscitation also may include other treatment, such as drugs, tubes and electric shock. People with terminal illnesses or other serious medical conditions may prefer to focus on comfort care at the end of life rather than receiving CPR when the time comes. For more information about the pros and cons of CPR and whether it is right for you, ask your physician. It is easy to make your wishes about CPR known. If you want to receive CPR when appropriate, you do not need to do anything. Health care providers are required to perform CPR when necessary. If you do not want CPR, you need to discuss your wishes with your physician and ask your physician to write a DNR Order. If your physician agrees that you should not get CPR, he or she can fill out the required form to make your wishes known in case of an emergency. There are different DNR orders that you can choose and discuss with your physician. Under Ohio’s DNR Law, the Ohio Department of Health has established a standardized DNR form. When completed by a physician (certified nurse practitioner or advance practice nurse, as appropriate), these standardized DNR orders allow patients to choose the extent of the treatment they wish to receive or not receive at the end of life. Your physician can further explain the differences in DNR orders. Even if you are healthy now, you may want to state that you do not want to receive CPR if you ever become terminally ill. Ohio has a standard Living Will Declaration form. This form specifically allows you to direct your physician not to administer life-sustaining treatments, including CPR, and to issue a DNR Order if two physicians have agreed that you are either terminally ill or permanently unconscious.
oes NOT meean “Do Nott Treat.” DNR Comffort Care do The DNR Comfort C Caree Protocol is very specifiic in terms oof what treatm ment is to bee given and w what ttreatment is to be withheeld. Only tho ose items lissted on the “w will not” listt are to be w withheld. Thee items a other treatment that m may be needded for the ppatient’s conndition, listed on thee “will” list, along with any m may be prov vided as apprropriate. DNR Orderrs may be reevoked. Y You alwayss have the rig ght to chang ge your mind d and request CPR. If yyou do changge your minnd, you should speak with your physician right r away about a revokinng your DN NR Order. You also shouuld tell yyour family y and caregiv vers about your y decision n and throw w away any DNR identiification item ms you m might have. der or identtification, yo our family ccannot dem mand that CP PR be proviided. If you have a DNR Ord Y You have th he right to maake your ow wn decisions about your hhealth care. Y You should make sure yyour ffamily know ws your desirres about CP PR. In certain n medical sittuations, youur physician and agent m may m make decisio ons regardin ng your care based upon new medicaal informatioon. This coulld include ddecisions rellated to CPR R. You shoulld make suree these indivviduals know w your desirees about CPR R. S Since a DNR R is a mediccal order, yo ou need a physician to write and ssign it for yoou. U Unlike Livin ng Wills and Health H Care Powers of Attorney, A DNR R Orders muust be writtenn and signed bby a pphysician, ad dvanced practice nurse or certified nurrse practitionner after conssultation withh the patient. C Copies of th hese forms should s be keept in easily y accessible places wherre others caan find them m. Y You also sho ould give copies of yourr Living Willl, Health Carre Power off Attorney annd/or DNR O Order to yyour physiciian, family members m and d any close friends f who m might serve as caretakerrs. At home,, a DNR oorder shoulld be display yed promin nently eitherr on the refrrigerator orr elsewhere so that an eemergency responder will w see it.
Th he Ho ospic ce C Choic ce W When choicces seem few w and unpleeasant… … there is hospice. h Lifee is full of ch hoices. We all want to be b in control, capable of making our own decisions, and determine how we w live our lives. When cure is no lo onger is possible, we experience fear, f frustration and conffusion. We can feel as if we have lo ost control off our lives. Hospice help ps to restoree our ability to t make decisions, to o put life bacck on track by b offering ppositive cho oices as we confront c life’’s end. W What does hospice offeer? Hospice pro ovides care for fo a patient by b an interdisciplinary team co omprised off physicians, nnurses, sociaal workers, counselors, c home h health aides, chaplaains, therapiists and volu unteers as nneeded. In addition, ho ospices help provide medicationss, durable meedical equipm m ment, supplies and d inpatient caare. The hospice providees care on a 24 4-hour, 7-day y a week bassis, always tthere to assist with crisees or concern ns that may arise. Moreover, hospice h is a philosophy p of o care which h w wraps aroun nd patient wiishes: your wishes w will be b rrespected an nd that you will w be allow wed to die, ass ppain free as possible, surrrounded by y those who love you, an nd with the utmost u respecct and dignity. Hosspice focusess on improviing the quality of liffe that remaiins, rather th han just increasing th he quantity.
When ccan I choose hospice? People who choosee hospice havve medical conditioons that no llonger can be cured, andd who are appproaching thee last phase oof life. Hosppice, with moore than fouur decades off experience in caring ffor the termiinally ill, offfers tremenddous advanc es in pain m management tthat dramatically improvve quality of life. Where is hospice ccare provided? Hospicee services geenerally are provided in the soothinng, familiar ssurroundingss of your hom me where yyou are mostt comfortablle and wheree loved ones caan be involveed more easiily. If you livve in a nursingg home or assisted livingg facility, hosspice care is pprovided in tthose locatioons as well. On occasioon, an individdual may choose to go too an inpatiennt facility to receive inteensive hospicce care focusedd on treating pain or otheer symptomss that cannot bbe treated inn their home environmennt. Once these syymptoms aree under contrrol, an indivvidual will usuually return hhome. If I chooose hospicee care, how will I pay foor the servicees? Medicaare, Medicaidd and most pprivate insurrance compannies cover thhe costs of hoospice care. Local hospicees will work closely withh you to idenntify possiblee sources off payment. H Hospice, the uultimate expresssion of caringg, support annd love, has served millionss of people oof all incomee levels, racees, creeds, ages and meedical circum mstances. Hoospice is here tto help you w when neededd.
C Can a hospiice patient who w shows signs s of rrecovery bee returned to o regular medical m ttreatment? Y Yes. If the in ndividual's condition c seeems to iimprove, thee patient can n be discharg ged from hhospice and return to aggressive therrapy or go oon about his or her daily y life. If a disscharged ppatient should later need d to return to o hospice ccare, Medicaare and mostt private insu urance ppolicies allow additionall coverage fo or this ppurpose. W What does the t hospice admission process p iinvolve? O One of the first fi things ho ospice will do d is to ccontact the patient’s p phy ysician to maake sure he oor she agrees that hospicce care is app propriate forr tthis patient at a this time. If an individ dual does nott hhave a physiician, hospicces may havee medical sstaff availab ble to help deetermine elig gibility. Once a patient is identified as appropriate for hospice ccare, he or sh he will be assked to sign consent and d iinsurance fo orms. These are a similar to o the forms ppatients sign n when they enter a hosp pital.
hoice? How doo I make the hospice ch Speak tto your physician, clergyy, hospital dischargge planner, ssocial workeer, nurse or llocal/ state hoospice organnization. Wheen you and yyour family rrealize that ccare, insteadd of cure, is m most importaant to you, thhat is when tto ask for hoospice. If I waant to mak ke the hospice choice and need more infoormation about Oh hio’s hospicees, who can help me? The Miidwest Care Alliance, whhose missionn is to prom mote the deveelopment annd delivery oof highest quality, endd of life care through advocaccy of hospicce philosophyy and standardds, can provvide this infoormation. Caall 800-7766-9513 or viisit www.m midwestcareaalliance.org
IIsn’t hospicce care just for people who w h have cancerr? N No. Hospicee care is avaiilable for pattients with m many termin nal illnesses such as amy yotrophic llateral sclero osis (ALS), dementia, d heeart disease, H HIV/AIDS, liver diseasee, pulmonary y disease, sstroke, comaa and other conditions. c In nquire at yyour local ho ospice to leaarn more.
For moree information n about orgaan, eye and tissue t donatiion, please contact www.don natelifeohio..org or your local organ pro ocurement organization:
It is impportant to lett your loved ones know that youu have Advannce Directivves. This cardd is providded for yourr use. Please complete thhe card andd place it in your wallet or purse so yyour wishes w will be know wn to medicaal professionnals.
Life Con nnection of Toledo T 3661 Briarfield Boullevard, Suitee 105 Maumee, OH 43537 (419) 893 3-1618 (800) 262 2-5443 www.lifeeconnectiono ofohio.org
Name: Address: City: State: Phone:
Life Con nnection of Dayton D 40 Wyom ming Street Dayton, OH O 45409 (937) 223 3-8223 (800) 535 5-9206 www.lifeeconnectiono ofohio.org
I have a Living Will. I have a Healthcare Power of Attorney Form. I am an Anatomical Gifts Donor and have registered with the Bureau of Motor Vehicles.
Life Cen nter Organ Donor D Netw work Southweestern Ohio 615 Elsin nore Place, Suite S 400 Cincinnaati, OH 4520 02 (513) 558 8-5555 (800) 981-5433 www.lifeepassiton.org g
Emergency Health Care Information Advance Directives Wallet Card