Communicating Your Healthcare Choices
Individuals usually make decisions regarding their healthcare treatment after their physician recommends a course of treatment and provides information about the treatment options. These decisions become more difficult if patients are unable to tell their physicians and loved ones what kind of healthcare treatment they want. We encourage patients to discuss their specific wishes with their family members/close friends, and to put details in writing to avoid confusion or misunderstanding.
Consent to Treatment
You have the right to decide what may be done to your body during the course of medical treatment. Your physician will discuss the nature of your condition, the proposed treatment and any alternate treatments that are available. Your doctor will also provide you with information about the risks associated with surgical and invasive medical procedures. This information will help you make an informed decision about the kind of treatment you want to receive. For certain procedures, you may be asked to sign a Consent Form, verifying that you understand what your physician has told you.
If you become unable to make your own healthcare decisions, and you have not provided an Advance Directive, your doctor or other healthcare provider will look to the following people (in the order listed) for decisions about your healthcare:
- Legal guardian or your Medical Power of Attorney agent
- Spouse, unless you are legally separated
- Adult child (if you have more than one adult child, the doctor or healthcare provider must seek consent of a majority of those children reasonably available)
- Domestic partner, if unmarried
- Close friend
Arizona law allows you to make certain decisions and provide guidance as to your wishes about your future medical care. These laws provide an opportunity for you to decide (1) who will represent you and (2) what medical care you want if you become ill and can no longer make medical treatment decisions for yourself. Documents known as Advance Directives give individuals the ability to express their treatment preferences before they actually need care, ensuring that their wishes will be carried out and that their families or others will not be faced with making difficult decisions without guidance. You are not required to prepare these documents, but if questions arise about the kind of medical treatment you want or do not want, Advance Directives may help solve these important issues.
The documents are called “Advance” Directives because they are signed in advance to let your doctor and other healthcare providers know your wishes. They include:
- Living Will—a document that describes the kind of life-sustaining care you want if you become terminally ill and are unable to make your own decisions. A Living Will does not serve as “Do Not Resuscitate” orders or necessarily prevent life-saving efforts from occurring. Through a living will, you can direct the withholding or withdrawal of any procedure or treatment that would only serve to prolong the dying process.
- Even with a Living Will, the law still allows your doctor to continue providing treatment to assure your comfort. This treatment could include giving pain medication and performing other procedures to make you more comfortable, even though all other life-support measures may have been withdrawn.
- Health Care Power of Attorney—allows you to designate another person to make healthcare decisions for you if you are unable to communicate your wishes. There are no restrictions on the number of instructions you can give to your designee in this document.
- Mental Health Care Power of Attorney—allows a patient to designate another adult to make his or her mental healthcare decisions if he or she is “incapable.” To be considered incapable, a licensed psychologist or psychiatrist must certify the patient is unable to give an informed consent. A Mental Health Care Power of Attorney must be in writing, agreed to by a patient while he/she is able to give informed consent and notarized or witnessed. The person given Power of Attorney can only make decisions consistent with the patient’s wishes specified in writing. A patient can revoke his or her Mental Health Care Power of Attorney – even if he or she is considered “incapable” – unless there is an express provision in the document to the contrary.
Forms for the Living Will and the Health Care Power of Attorney will be made available to you during your registration process at your request. You can also request them from your (or the patient’s) nurse.
If you have any questions, or need assistance filling out these forms, please inform your nurse. If you have an existing Advance Directive, Living Will or Health Care Power of Attorney, please provide the hospital with a copy as soon as possible or consider completing new ones. This ensures that we understand and follow your wishes. You have the right to revise your advanced directive at any time.
Spiritual Care Services and/or Case Management staff are available to provide emotional support and guidance in medical decision-making, as well as explanations about resuscitation status, Living Wills and Health Care Powers of Attorney. Please inform your nurse that you would like to talk with someone regarding medical decision-making and/or Advanced Directives so that she/he can make the appropriate referral.
- Pre-hospital Medical Care Directive (Do Not Resuscitate Directive)—a document that designates whether you want emergency treatment by paramedics prior to admission or in the Emergency Department of your hospital. You can refuse CPR, assisted ventilation, emergency drugs, intubation or defibrillation. Your primary care physician can assist you in obtaining this advanced directive.
At any time, you can cancel or change any of these documents. To cancel your directive, destroy the original document and tell your family, friends, doctor or anyone else who has a copy that you have cancelled or changed it. To change your advance directives, simply write and date a new one and give copies to all appropriate parties, including your doctor.
Notice of Privacy Practice
The privacy regulations adopted under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) govern the use and release of a patient’s personal health information, also known as “protected health information” (PHI).
Under the HIPAA privacy regulations, a Joint Notice of Privacy Practices is provided to all patients. This notice provides patients with information about how their PHI will be used and how, in certain situations, patients are given the opportunity to restrict the use of their PHI. Hospitals may use and disclose PHI without a patient’s authorization for the purpose of treatment, payment and healthcare operations.
We ask that you identify one person who can be your communication representative to share information you wish to be disclosed to family members or loved ones. If you are unable to make decisions for yourself, the medical team will be sharing your health information with your Health Care Power of Attorney or your assigned Surrogate Decision-Maker. Please refer to the “Consent to Treatment” section of this booklet for more details.