Advances in modern medicine have saved and prolonged many lives. However, these advances have raised many questions about using machines to prolong the
natural dying process for terminally ill patients. Individuals are now more
frequently asking how they can have more control over their medical care at
the end of their lives.
It Is Your Decision
On December 1, 1991, a federal law went into effect that requires hospitals to discuss this issue with admitted patients who are 18 years or older. Kentucky law also recognizes your right to make choices about your medical care. You have the right to request or refuse treatment and to ask that treatment be discontinued. You also have the right to make an ADVANCE DIRECTIVE.
An advance directive is a legal, written provision made by an individual concerning decisions that may come up about his or her health care in the future—such as the use of life support machines and life prolonging medical treatment. An advance directive can also be used to appoint someone to make health care decisions for you if you should ever become unable to make your own decisions. Three types of advance directives can be used in Kentucky: Advance Directives for Mental Health Treatment, Durable Powers of Attorney, and Living Will Directives.
Advance Directive for Mental Health Treatment
This document allows an adult to make his wishes known regarding certain mental
health treatments. It also allows that person to appoint someone else (a surrogate) to make sure the provisions of the document are carried out. Covered in an Advance Directive for Mental Health Treatment are:
refusal of specific psychotropic medications,
refusal of electric shock therapy, stating
preferences for psychotropic medications
and procedures for emergency interventions.
This document enables adults to make their wishes known in writing regarding which medical treatments they do and do not want, before there is a medical emergency, the onset of a permanent unconscious state or a terminal condition. A terminal condition is a condition which cannot be cured, cannot be reversed and which will cause death in a short period of time. Anyone 18 years of age or older and of sound mind can sign a living will directive. This document is only in effect when the individual can no longer make decisions for him/herself and is found to be in a terminal condition. This document also allows patients to choose another adult to speak for them concerning medical treatment when they can no longer speak for themselves. Subject to certain exceptions in the laws, the surrogate would have the power to authorize the withholding or withdrawal of life prolonging treatment. The surrogate may be anyone 18 years of age or older, of sound mind and able to make a decision. The designee cannot be an employee of a hospital unless he/she is a relative of the individual.
Durable Power of Attorney
This document allows individuals to designate another adult to make health care decisions for them when they are no longer able to decide for themselves.
This document can also include personal and financial decisions. Please note that
if a power of attorney document does not specifically contain the language that allows the designee to make healthcare decisions, the designee may not do so.
„. Jennie Stuart Medical Center will make each individual’s advance directive a
part of his or her medical record when the completed document is received.
The individual must discuss the advance directive with his/her physician.
If a physician morally, religiously, or professionally cannot honor an individual’s advance directive decision, JSMC staff and the physician will not impede the transfer of the patient to another physician/facility that can meet the patient’s request.
„. A Living Will only becomes valid in the event you are considered being near
end of life, permanently unconscious, or are unable to communicate or make
your own decisions. Until then, you will be asked to make health care decisions
for yourself. If your Living Will states you want no extraordinary life support
measures, you will still be provided routine care and pain control.
„. The contents of a Living Will are not permanently binding. A Living Will
can be invalidated by shredding the document. A new Living Will can then
„. Your hospital or other health care providers must see your original Living Will or Advance Directive every time you are admitted for care even though you do not need to execute a new document each time. This action helps us make sure
we have your most updated directive.
„. Just provide the original document on admission and ask that a copy be made
for your medical record, be sure the original is returned to you.
Special Considerations For Surgical Procedures:
It is the general p „. olicy of the operating room and anesthesia department to
institute life sustaining measures as an inherent component of the operative
experience. Therefore, the instructions identified on the Advance Directive by
the individual will not be honored in this specific situation.
For Outpatient Areas of JSMC:
„. Because medical evaluation by a physician is not always available in outpatient settings, it is the general policy to employ life saving measures.
Such outpatient areas include the Wound Center, Outpatient Diagnostic
Center, Cardiac and Pulmonary Rehabilitation, Outpatient Laboratory and
Radiology Services, and Convenient Care.
For the Emergency Department::
„. If you are brought into the Emergency Dept. for care, please bring a copy of
your Advance Directive. If the Emergency Dept. physician determines that your
condition is not near end of life, your Advance Directive will not be in effect.
If the Emergency Dept. physician determines your condition is near end of life and you are unable to make your own decisions, Your Advance Directive will be honored IF the ED staff has received the copy and are aware of your wishes.
Without an Advance Directive
You will not be required to make an advance care by any physician, health care facility, or other health care provider. Jennie Stuart Medical Center will not discriminate against any patient based on the presence or absence of an advance directive.
Exceptions to Your Directive
Please understand that, in some cases, having an advance directive will not mean that life sustaining machines and other treatments will not be used. Remember that your directive takes effect only when you are terminally ill or permanently unconscious and no longer able to make decisions for yourself. Living Will Directives are not effective for those patients who are pregnant. Pregnant patients who have designated a surrogate will receive treatment unless the attending doctor and one other doctor document that providing treatment will not allow the baby to be developed or born alive, or that the patient will suffer prolonged pain or harm as a result of the treatment and nourishment.
Laws vary from state to state: however, through Kentucky law you can include a
statement concerning your wishes to donate your tissues and organs after death in the Living Will document. As an additional step, you may also sign the organ donor designation section found on the back of your driver’s license. If you take this step, be sure to have your signature witnessed as indicated.
Kentucky law recommends that all hospitals and doctors obtain your family’s consent to honor your decision after death, even if you have consented to organ donation. It is very important that you discuss your decision to donate your organs and tissues with all the appropriate members of your family.
Being an organ donor will not affect the care you receive. If you are injured or ill and are taken to a hospital emergency room, you will receive the best possible care whether or not you are an organ donor. Donation procedures begin only after all efforts to save your life have been exhausted and death has been declared.
Kentucky and federal funds pay all costs related organ and tissue donation.
For Additional Information Contact
Division of Aging Services:
Kentucky Organ Donor Affiliates:
Office of the Attorney General:
American Society for
Healthcare Risk Management:
The material presented related to Advance Directives is for informational purposes only, and should not be considered legal advice or used as legal advice. On all these matters, you should consult your own attorney.
Jennie Stuart Medical Center takes no position whether a person should execute an Advance Directive.