Advance Directives

Living Will & Durable Power of Attorney Forms

Note: Scott County Hospital makes these forms available, but patients are welcome to use Advance Directive forms from other sources.

Notice of Advance Directives Policy
We respect your right to make your own medical treatment decisions
In order to help you exercise this right, we offer the following information

WHAT ARE “ADVANCE DIRECTIVES”?
Advance Directives are signed written instructions relating to the provision of health care when an individual is incapacitated. An individual can implement an Advance Directive only for themselves; not another person. Advance Directives recognized by Kansas statutes include a Living Will, a Durable Power of Attorney for Health Care and a Do Not Resuscitate Directive.

• A Living Will states that life-sustaining procedures should be withheld or withdrawn when decision making capacity is lost and when such procedures would merely prolong death. Medical procedures deemed necessary to provide comfort or “alleviate pain” are not considered “life-sustaining procedures.” A Living Will doesn’t not take effect until two physicians have certified the patient is terminally ill. A Living Will is not effective during pregnancy.

• A Durable Power of Attorney for Health Care is a document in which an individual gives someone else the right to make decisions about health care for him/her. A Durable Power of Attorney for Health Care does not go into effect until the individual can no longer receive and evaluate information effectively or communicate their decisions as determined by their physician. The Durable Power of Attorney for Health Care can be used with caution during pregnancy, provided decisions do not adversely affect the viability of the fetus. Kansas does not currently have a specific statute for a Psychiatric Advance Directive, however a Durable Power of Attorney for Health Care can be written to authorize the agent to make decisions about mental health as well, therefore you are encouraged to discuss your wishes regarding psychiatric treatment with your chosen agent(s).

• Do Not Resuscitate (DNR) Directive
DNR is Do Not Resuscitate and CPR is Cardio-Pulmonary Resuscitation
DNR means you do not want CPR. CPR means medical procedures which are intended to restart breathing or heart functioning and include chest compressions, assisted ventilation, intubation, defibrillation, administration of cardiotonic medications or other medical procedures which are intended to restart breathing or heart functioning. A DNR Directive is typically only used by terminally ill patients. Both you and your physician must sign and date the DNR Directive.

A physician who is unwilling to comply with an individual’s Advance Directive, due to personal beliefs or values, will make arrangements for transfer of care to another physician, pursuant to K.S.A. 65-28, 107.

PROVISION OF NOTICE OF ADVANCE DIRECTIVES POLICY
All adults or emancipated minors who are admitted to any level of care at Scott County Hospital will be given written notice of Scott County Hospital Advance Directives Policies, including where to file complaints concerning Advance Directive requirements. If the individual is incapacitated or otherwise unable to communicate, the next of kin will be provided with this information.
COMPLIANCE WITH STATE LAW
We will ensure that we are in compliance with the requirements of state law, whether statutory or as set forth in applicable court cases, on the subject of informed consent to medical treatment and the formulation of Advance Directives by our patients.

RIGHT TO CHOOSE
Adult individuals and emancipated minors have the right to make decisions concerning their care, including the right to accept or refuse medical or surgical treatment and the right to formulate, at the individual’s option, Advance Directives as permitted under state statutory and case law.

Adult individuals and emancipated minors also have the right to have hospital staff implement and comply with their Advance Directives.

Medical treatment decisions are a matter of personal choice. We are committed to providing each patient or patient’s legal representative with the information he or she needs to understand and consider the options available under state law.

DOCUMENTATION
We will document in your medical record whether or not you have executed an Advance Directive. We will request a copy of your directive to guide health care decisions. Although we will provide information we hope will be helpful to many patients in understanding their options, we are not permitted to give either medical or legal advice. Such consultation, if needed or desired, should be sought from a qualified lawyer or physician.

NON DISCRIMINATION
Whether or not a patient chooses to execute an Advance Directive is a personal matter and will never be a condition of providing care or a basis for discrimination against you.

EDUCATION
We provide or participate in providing education for staff and community on issues relating to Advance Directives.

COMPLAINTS/GRIEVANCES
Medical treatment decisions sometimes raise difficult issues for patients, family members, and the care team to deal with. We are committed to discussing and resolving these questions as they arise. If you have questions or are unsure about our policies, please ask for further clarification.

If you have any questions, concerns or complaints about Advance Directives requirements, you may do any of the following:
• Contact your nurse and/or ask for Social Services
• Fill out a grievance form. Grievance forms are available at the nurses’ station, at the front desk, or from the Scott County Hospital Risk Manager/Quality Improvement Coordinator
• Contact the Scott County Hospital Risk Manager/Quality Improvement Coordinator at 620-872-7753
• Call KDHE—Kansas Department of Health and Environment at 800-842-0078