What is the purpose of an advance directive?
If a serious medical condition prevents you from communicating your treatment decisions, the responsibility for making decisions about your care will fall to your family, physician, hospital or sometimes a court of law. Preparing an advance directive, however, allows you to express your wishes regarding end-of-life treatment when you are unable to choose or refuse various types of medical care for yourself.
This information explains your rights to make decisions about your own health care under New Jersey law, and your rights as a patient. It also tells you how to plan ahead for your health care if you become unable to decide for yourself because of an illness or accident.
What types of medical conditions and treatments are involved?
An advance directive is only implemented under specific conditions, when people are determined to be unable to make healthcare decisions or speak for themselves. Patients must have a terminal illness, or conditions that leave them in a persistent, vegetative state such as severe brain damage and coma before their advance directive would be implemented. Some of the more common treatments people may want to address when preparing an advance directive include: cardiac resuscitation, respirators or breathing machines, artificial or tube feedings, renal or kidney dialysis, antibiotic treatments, blood transfusions and surgery.
What should be considered before establishing an advance directive?
Prior to preparing an advance directive, people are encouraged to answer these questions based on their beliefs and backgrounds.
Do you want any of the following medical treatments performed?
- Kidney dialysis if your kidneys stop working.
- Cardiopulmonary resuscitation or CPR if your heart stops beating.
- Assisted-breathing through a ventilator or respirator, which is a machine that breathes for you if your lungs are not working.
- Artificial nutrition if you cannot feed yourself.
- Artificial hydration if you are unable to drink fluids.
- What are your feelings about life-sustaining measures if you had a terminal disease?
- How do you feel about living alone and being independent?
- Do your religious beliefs affect your feelings about illness and death?
- Do you want to donate parts of your body at the time of your death? (This is called organ/tissue donation.)
- What would be important to you if you were dying e.g., physical comfort, relief from pain, presence of family members, etc.?
- Should your doctor make the final decision about needed medical treatments?
- Do you expect family, friends and others to support your medical decisions?
- Is there one family member who you know would respect your wishes that you would choose as your decision maker, healthcare proxy or representative?
- Are you comfortable signing a legal document that states who will make your medical decisions?
- Do you have any other medical wishes that you want people to know?
Can I change my mind?
An advance directive can be changed at any time, and does not become effective until the time when you can no longer make medical decisions for yourself and are terminally ill. Be sure to notify your proxy if your beliefs change.
Are there different types of advance directives?
An advance directive is a legal document, which anyone age 18 or older can have, that describes your medical wishes in the event that you were unable to make decisions for yourself. There are three different types of advance directives.
Instruction directive or living will is a document that instructs healthcare providers about your medical choices, including treatments you do or do not wish to receive.
Proxy directive or durable power-of-attorney is a document in which you name another person (proxy) to make healthcare decisions for you.
Combined directive includes instructions about treatments you prefer or want to avoid, and allows you to pick a person to state your wishes for medical treatment.
Who should I talk to before filling out an advance directive?
While choices concerning life and death are personal ones, they also affect the people who are close to you. For this reason, it is often helpful to discuss your medical choices with your family, friends, spiritual advisor, physician, and proxy if you choose one. Questions about the kinds of medical procedures that are used when illness is severe and recovery unlikely can be best answered by your physician. While you may consult an attorney if you wish, it is not necessary.
Must physicians, family and others follow my advance directive?
Yes. Everyone responsible for your care must respect your decisions as stated in your advance directive. This is a legal document that must be signed, dated and witnessed by two people or notarized. The person you choose to be your proxy or healthcare representative must be at least age 18. If your doctor, nurse, or other professional, however, has a sincere objection to your decision to refuse life-sustaining treatment, he or she may have your care transferred to another professional who will follow your wishes.
What should I do with my advance directive?
You should give a copy to your family physician, healthcare representative or proxy, family member(s) and other people who are close to you. Bring a copy when you are admitted to a hospital, nursing home or other healthcare facility. Your advance directive becomes a part of your medical record. We ask you for a copy during each admission, to insure that we have the most current copy that reflects your wishes. Keep a copy of your advance directive in a safe place so it can be located if needed.
Do I need an advance directive to be treated or admitted to the hospital?
No. If you do not have an advance directive, it will in no way affect the quality of care you are provided. You do not have to fill out any of the advance directive forms that may be presented to you at a hospital, and you will still get medical treatment. Furthermore, your insurance company cannot deny coverage based on whether or not you have an advance directive.
How can I get a copy of an advance directive form?
If you need assistance or would like a copy of an advance directive form, please call one of the Virtua facilities below and ask for the Patient Relations Department.
- Virtua Camden
(856) 246-3598, ext. 63598
- Virtua Marlton Hospital
(856) 355-6555, ext. 56555
- Virtua Mount Holly Hospital
(609) 267-0700, ext. 43254
- Virtua Voorhees Hospital
(856) 247-3555, ext. 73555