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UC Davis Medical Center

UC Davis Medical Center

Express your health-care wishes with an advance directive

Document helps family, physicians with decisions

health-care provider at bedside
Preparing an advance directive — a document specifying your wishes and/or a person who can make decisions on your behalf — can save others from painfully difficult decisions about your care, and help them respect your wishes.

If you had a serious illness or injury, would your loved ones or physicians know the medical treatment you would want? And who would make these decisions for you?

April 16 is National Healthcare Decisions Day, an initiative to encourage patients to express their wishes regarding health care — and for providers to respect them.

The effort, supported by the American Hospital Association, Association of American Medical Colleges, AARP and other national health-care organizations, specifically encourages adults to complete a written “advance directive” that spells out their wishes and decision-making preferences in writing.

When patients don’t have an advance directive and are not conscious or able to sign one during medical care — such as trauma victims, for instance — it may leave their family members, loved ones and physicians to make difficult and stressful decisions on their behalf.

Because these people may not know the patient’s wishes, it also becomes more difficult for them to guide medical care that would reflect those wishes. 

A common issue

According to a Pew Research Center report on end-of-life treatment cited by NHDD, 42 percent of Americans have had a friend or relative suffer from a terminal illness or coma in the last five years. For a majority of these people — and 23 percent of the general public — the issue of withholding life-sustaining treatment emerged.

Yet according to NHDD, the U.S. Agency for Healthcare Research and Quality reported in 2003 that less than 50 percent of the severely or terminally ill patients studied had an advance directive in their medical record.

Only 12 percent of patients with an advance directive had received input from their physician in its development, and between 65 and 76 percent of physicians whose patients had an advance directive were not aware that it existed.

Filed in your electronic record

For a sampling of California-specific advance directive information and models that are available on the Internet, see the end of this article.

Under UC Davis policy, health-care staff will offer written information on advance directives to adults and emancipated minors upon inpatient admission. This brochure explains advance directives in more detail, and contains worksheets to help patients identify their goals, values and types of treatment choices. Patients with questions about advance directives can contact UC Davis Medical Center’s Clinical Social Services or Patient Assistance departments for further assistance.

During hospital admission staff will also ask patients if they already have a directive. If so, the information is recorded in the electronic medical record.

Since laws on advance directives differ from state to state, it’s best to use forms legally recognized by California. Californians also need to sign and date their advance directive before two witnesses or a notary public.

Additional option for serious illness

... An advance directive is still necessary to appoint a legal health care decisionmaker, and is recommended for all adults, regardless of their health status.

To supplement an advance directive, California patients who are seriously ill or in poor health also have the option of completing a POLST form. Short for “Physician Orders for Life-Sustaining Treatment,” the POLST form states what kind of medical treatment patients want toward the end of their lives, and is signed by both a doctor and patient.

The decisions documented on the POLST form include whether to attempt cardiopulmonary resuscitation, administer antibiotics and IV fluids, use a ventilator to help with breathing or provide artificial nutrition by tube.

The POLST form complements an advance directive and is not intended to replace that document, according to the Coalition for Compassionate Care of California, the statewide partnership that leads the California POLST Project. The coalition notes that an advance directive is still necessary to appoint a legal health-care decisionmaker, and is recommended for all adults, regardless of their health status.

More information

UC Davis patients with questions about advance directives can contact the medical center’s Clinical Social Services or Patient Assistance units for assistance.

Here is a sampling of California-specific advance directive information and models available on the Internet:

California Hospital Association advance directive form (PDF)
http://www.calhospital.org/sites/chadocuments.org/files/file-attachments/Forms_3.pdf 

POLST form
http://finalchoices.org/polst.php#form 

Caring Connections (National Hospice and Palliative Care Organization)
http://www.caringinfo.org/PlanningAhead.htm (overview and links to state-specific forms, including California)

California Attorney General, including Probate Code sample form
http://ag.ca.gov/consumers/general/adv_hc_dir.htm 

California Medical Association
http://www.cmanet.org/publicdoc.cfm?docid=731&parentid=725