Deciding About Health Care

1 Deciding About Health Care A GUIDE FOR patients AND FAMILIES. New York State Department of Health 2. What if it's unclear whether or not a patient Introduction has decision-making capacity? Who decides Who should read this guide? whether or not the patient has capacity? This guide is for New York State patients and Health care workers will assume patients have for those who will make Health care decisions decision-making capacity, unless a court has for patients . It contains information About appointed a legal guardian to decide About surrogate decision-making in hospitals and Health care. A doctor will examine the patient if nursing homes. It also covers DNR orders there is good reason to believe the patient lacks in a Health care facility, or in the community. capacity. A doctor must make the determination Because this guide is About Health care that a patient lacks the ability to make Health decision-making, the word patient is used to care decisions.

2 Another person will make Health refer to anyone receiving medical care. This care decisions for the patient only after the includes a nursing home resident. This guide patient's doctor makes this determination. does not include the special rules for Health Do family members always make Health care care decisions made by legal guardians of decisions whenever patients lack decision- persons with developmental disabilities. making capacity? Can the patient or other decision maker find No. Sometimes patients have already made out About the patient's medical condition and a decision About a procedure or treatment proposed treatment? before they lose the ability to decide. For Yes. patients or other decision makers have example, a patient can consent to surgery that a right to be fully informed by a doctor About involves general anesthesia before receiving their medical condition and the doctor's anesthesia, which would cause them to lose proposed treatment.

3 patients must give the ability to decide. Other times, a healthy informed consent before any non-emergency person may suddenly lose capacity. In this treatment or procedure. Informed consent case, Health care may need to be given right means that after information is given About away without consent. For example, a person the benefits and risks of treatment (as well as may be knocked unconscious during an alternatives to the treatment) permission is accident. Health care providers will provide given to go ahead with the treatment. emergency treatment without consent unless they know that a decision has already been Adult patients Who Have the made to refuse emergency treatment. Ability to Make Informed Decisions Advance Directives/. Do adult patients have a right to make their Health Care Proxies own Health care decisions?

4 Yes. Adult patients have the right to make What is an advance directive? treatment decisions for themselves as long as Advance directives are written instructions they have decision-making capacity. About Health care treatment made by adult patients before they lose decision-making What is decision-making capacity ? capacity. In New York State, the best way to Decision-making capacity is the ability to protect your treatment wishes and concerns is understand and appreciate the nature and to appoint someone you trust to decide About consequences of proposed Health care. treatment if you become unable to decide for This includes the benefits and risks of (and yourself. By filling out a form called a Health alternatives to) proposed Health care. It also care proxy, this person becomes your Health includes the ability to reach an informed care agent.

5 Decision. Before appointing a Health care agent, make sure the person is willing to act as your agent. 3. Discuss with your agent what types resident may not verbally make a decision to of treatments you would or would not want withhold or withdraw life-sustaining treatment if you were in the hospital and had a unless two adults witness the decision. One of life-threatening illness or injury. Make sure the adults must be a Health care practitioner your Health care agent knows your wishes at the facility. If a patient does not now have About artificial nutrition and hydration (being capacity to make a decision (but made a fed through a feeding tube or IV line). You can decision in the past About the proposed get more information About Health care proxies Health care), the hospital or nursing home at: will act based on the patient's previously patients /health_care_proxy/ made decision.

6 This is true unless something Some patients also express specific occurs that the patient did not expect and the instructions and choices About medical decision no longer makes sense. treatments in writing. A written statement can How are Health care decisions made for a be included in a Health care proxy, or it can be hospital patient or nursing home resident who in a separate document. Some people refer to does not have capacity? this type of advance directive as a living will.. If the patient has a Health care proxy, the How do Health care agents make decisions Health care agent named in the proxy makes under a Health care proxy? decisions. If a patient does not have a Health Health care agents make decisions just as care proxy, a legal guardian (or the person if the Health care agent were the patient.)

7 Highest in priority from the surrogate list, The Health care agent makes Health care known as the surrogate ) makes decisions. decisions according to the patient's wishes, What is the surrogate list? including decisions to withhold or withdraw Below is the surrogate list. The person who life-sustaining treatment. If the patient's wishes is highest in priority is listed at the top. The are not reasonably known, Health care agents person with the lowest priority is at the bottom. make Health care decisions in accordance with the patient's best interests. The spouse, if not legally separated from the patient, or the domestic partner;. Can a Health care agent decide to withhold A son or daughter 18 or older;. or withdraw artificial nutrition or hydration (through a feeding tube or an IV line)? A parent;. Health care agents can only make decisions A brother or sister 18 or older; and to withhold or withdraw artificial nutrition and A close friend.

8 Hydration under the Health care proxy if they What is a domestic partner ? know the patient's wishes About the treatment. A domestic partner is a person who: But, the Health care agent may also be able to make this type of decision in a hospital or has entered into a formal domestic nursing home as a surrogate from the surrogate partnership recognized by a local, state or list set forth in law. national government. Or, this person has registered as a domestic partner with a registry maintained by the Health Care Decision-Making government or an employer; or, this person in Hospitals and Nursing Homes is covered as a domestic partner under How do adult patients with decision-making the same employment benefits or Health capacity make decisions in hospitals and insurance; or, this person nursing homes? shares a mutual intent to be a domestic patients may express decisions verbally or partner with the patient, considering all the in writing.

9 A hospital patient or nursing home facts and circumstances, such as: 4. They live together. They depend on each other Decisions to Withhold or Withdraw for support. Life-Sustaining Treatment in They share ownership (or a lease) of their Hospitals and Nursing Homes home or other property. They share income or expenses. What is life-sustaining treatment ? They are raising children together. Life-sustaining treatment means that the They plan on getting married or becoming attending doctor believes the patient will die formal domestic partners. within a relatively short time if the patient They have been together for a long time. does not get the medical treatment or procedure. CPR is always considered to be Who cannot be a domestic partner? life-sustaining treatment. A parent, grandparent, child, grandchild, brother, sister, uncle, aunt, nephew or niece What is CPR?

10 Of the patient or the patient's spouse. CPR (cardiopulmonary resuscitation) refers to A person who is younger than 18. medical procedures that try to restart a patient's heart or breathing when the patient's heart Who qualifies as a close friend ? stops and/or the patient stops breathing. CPR. A close friend is any person, 18 or older, who may begin with something like mouth-to-mouth is a friend or relative of the patient. This person resuscitation and forceful pressure on the must have maintained regular contact with the chest to try to restart the heart. This may not patient; be familiar with the patient's activities, work, so CPR may also involve electric shock Health , and religious or moral beliefs; and (defibrillation); insertion of a tube down the present a signed statement to that effect to the throat into the windpipe (intubation); and placing attending doctor.