Governor John Kasich has issued a declaration stating that October 14-20, 2012, is Ohio Living Wills and Advance Directives Week. The week provides an opportunity for Ohioans to put in writing their future wishes regarding the care they want to receive through living wills and health care powers of attorney (HCPOA).
Several tools known as advance directives can help people take control of their future choices regarding medical care.
"Advance directives are verbal or written instructions about future medical care, in the event that a person is unable to speak for himself," explained Family Practice physician Richard Fawcett, M.D. "Advance directives are used to guide medical care decisions when a person is unconscious or too ill to communicate. However, if someone is able to express a decision, he or she can accept or refuse any medical treatment.
"Each state regulates the use of advance directives, and several types are available in Ohio, such as living wills, organ and tissue donation, health care powers of attorney and DNR orders."
Ohio's Living Will is one type of advance directive that only comes into effect when someone is terminally ill or permanently unconscious. A Living Will is the most common advance directive and is used in situations when a person is unable to tell a physician what kind of life-sustaining treatment he or she wants to receive. A Living Will affects only care that artificially or technologically postpones death. It does not affect care that eases pain or other treatments that are necessary to keep a person comfortable.
"Being terminally ill generally means that a person has less than six months to live," Dr. Fawcett advised. "To be considered permanently unconscious, two physicians must decide that the individual has no reasonable possibility of regaining consciousness and is also unable to communicate."
Organ and Tissue Donation
Ohio law requires that a Living Will created after December 2004, must include a person's preferences about donating anatomical gifts (organ and tissue donation). This advance directive allows people to make decisions about donating their organs and tissues ahead of time, and is asked again when obtaining or renewing a driver's license.
Health Care Power of Attorney
A Durable Power of Attorney for Health Care (DPOA-HC) becomes effective even if a person is only temporarily unconscious and medical decisions need to be made. "This type of advance directive is different from a financial power of attorney that is used to grant control of a person's financial matters," said Dr. Fawcett.
Do Not Resuscitate Orders
Ohio's Do-Not-Resuscitate (DNR) law gives people the opportunity to limit the care they receive in emergency situations and in special circumstances, including when medical help from emergency personnel is called. This advance directive allows a person to not be resuscitated in the event of a cardiac or respiratory arrest.
"A DNR order must be written and signed by a physician or a medical practitioner," Dr. Fawcett stated. "It addresses the various methods used to revive people whose hearts have stopped functioning or who have stopped breathing."
A person can have a DNR Comfort Care (DNRCC) following consultation with a physician regarding end of life issues. There are two types of DNR Comfort Care Orders: DNR Comfort Care and DNR Comfort Care-Arrest. Comfort care refers to any measure that is taken to diminish pain or discomfort, but not to postpone death.
"With a DNR Comfort Care Order, a person receives care to ease pain and suffering, but no resuscitative measures to save or sustain life," Dr. Fawcett explained. "With a DNR Comfort Care-Arrest Order, individuals receive all of the appropriate medical treatment up until the time that they have a cardiac or respiratory arrest. After that time, only comfort care is given."
Preparing an Advance Directive
A person can complete a Living Will or Durable Power of Attorney for Health Care form without the assistance of a lawyer, but these documents must be signed in the presence of a Notary Public. In contrast, a DNR Order can only be completed by a physician or nurse practitioner.
The Ohio Hospice and Palliative Care Organization offers an advance directives packet that can be used to create a living will or health care durable power of attorney, or to designate organ or tissue donation. This information is also available at:
"When you have a living will, make several copies and give them to a close relative, your lawyer and your physician," Dr. Fawcett concluded. "Discuss your wishes with as many family members as possible, to help relieve them from potential disagreements at a difficult time and ensure that the choices you make in advance will be carried out."
Richard Fawcett, M.D., is a Board certified Family practitioner and the Chairman of Salem Community Hospital's Bioethics Committee. He is affiliated with The Family Practice Center of Salem, 2370 Southeast Boulevard in Salem, 330- 332-9961.