Advance directives are verbal or written instructions given by individuals specifying what medical care they wish to receive, or abstain from receiving, should they become unable to make such decisions in the future. These orders ensure that a patient’s wishes about treatment are known and followed if they cannot speak for themselves due to incapacitating illness or injury.
Anyone 18 years of age and older should have a medical plan and advance directive. Advance directives are especially recommended for patients with terminal illnesses or those undergoing a serious surgical procedure. Even individuals in good health should consider preparing an advance directive in case of sudden accident or illness. In New York State, advance directives include, but are not limited to:
Health Care Proxy
In New York State, you may appoint someone to make medical decisions for you, should you lose the ability to speak for yourself. A designated family member or close friend is known as a Health Care Agent. The Health Care Proxy form specifies this individual and states that you give this person the right to make all healthcare decisions for you, including decisions about artificial nutrition and hydration and Do-Not-Resuscitate orders. Your specific wishes are not written out on the Health Care Proxy form, so make sure you discuss them with your Health Care Agent and that he or she is a person you trust.
Consent to a Do-Not-Resuscitate (DNR) Order
Under New York State Law, all adult patients can include a DNR order in their medical chart. Patients can request a DNR order verbally or in writing if two witnesses are present. A DNR order will stop doctors, nurses, and other healthcare practitioners from initiating emergency procedures if your breathing or heartbeat has stopped. This includes mouth-to-mouth resuscitation, external chest compression, electric shock, insertion of a tube to open your airway or injection of medication into your heart or open chest. Terminally ill patients may wish to have a DNR order to facilitate a natural, painless death or to avoid complications such as possible brain-damage after resuscitation.
A living will is a document written in advance that details your wishes about medical treatments and certain medical conditions. Your wishes should be expressed in a clear and convincing manner. If you should become seriously ill and unable to communicate, your living will can serve as evidence of your wishes and medical personnel will know how to respond in particular situations.
In anticipation of accidents or incapacitating injury, you should write a living will while you are healthy. You do not need a lawyer to oversee the documentation of a living will, and no witness needs to be present. However, it is advised that a lawyer help you draft your living will in order to clearly specify your desires about healthcare treatments and end-of-life options.
Medical Orders for Life-Sustaining Treatments (MOLST)
In New York State, the MOLST form outlines specific end-of-life wishes and is available for seriously ill patients. You and your physician will fill out the form together after discussing treatment options. The MOLST form is bright pink and easily recognizable. It is kept with you at all times so that it is still in effect when you leave the hospital or if you change hospitals. The form indicates a patient’s desires regarding resuscitation and medications to be given or withheld during end-of-life care.
The MOLST form does not replace a healthcare proxy or living will, which are documents available for all healthy adults. All three documents (healthcare proxy, living will and MOLST) are recommended for those patients who are seriously ill. A MOLST form is similar to a DNR order, but it is more specific, completed with your physician and transferable to different locations, including home.
Crouse Hospital maintains an Ethics Council, in partnership with Upstate Medical University, to help when patients and their families face difficult decisions regarding healthcare. Anyone, including physicians, staff, patients and their families may request a consultation.
An ethics consultation might be helpful when there is a question about:
- Patients’ Rights
- Advance Directives (Health Care Proxy, Living Will, MOLST)
- A Do-Not-Resuscitate (DNR) Order
- Withdrawal of treatment
- Informed consent (giving permission to receive treatment and understanding it’s effects)
- Palliative Care
- Family disagreements about care
Our Consultation Team
Crouse Hospital’s Ethics Consultation Team includes:
|Physician Chair:||Thomas Curran, MD|
|Ethics Consultants:||Provided by SUNY Upstate’s|
Center for Bioethics
There are two ways to access a Crouse ethics consultant:
A request for an ethics consultation can be made by any member of the hospital staff, a physician, clergy member, a family member or the patient.
Call 315-470-7111 or “0” (hospital operator) to reach the ethics consultation team member on call.
The ethics consultant will, the same day, contact the individual who made the request. The consultant will also speak with the attending physician. He or she will review the case with the concerned parties and facilitate a solution.
New York State Department of Health
The New York State Department of Health Web site provides current information about healthcare in New York State. Here you will find detailed explanations of all advance directives available in the state and links to forms. This site also provides information about health insurance, legal concerns, healthy lifestyles, and current health issues.
Information about NYS Patients’ Bill of Rights
Provided by the New York State Health Department, this document outlines 19 basic rights of hospital patients in New York. These rights include the right to information, the right to receive or refuse care and the right to information about your doctor.
New York Online Access to Health – Advance Directives by State
This Web site provides links to information about advance directives in each state. There are also general links to the American Bar Association and the U.S. Department of Health and Human Services. Particularly useful is the ABA’s publication, “10 Legal Myths about Advance Medical Directives.”
Compassion and Support
Compassion and Support sets direction for, oversees and ensures implementation of a set of broad end-of-life/palliative care projects that result in quality improvements in the lives of those facing death. Learn about their five-step approach to Advance Care Planning.
Compassion and Choices of New York
Compassion and Choice of New York is an organization that advocates for pain management and palliative care and provides information and resources about healthcare proxies, living wills and a range of end of life issues. It offers support, counseling and local referrals for patients and families.