You have the right to state your wishes regarding your medical treatment and heart transplant. A growing number of people are taking action before they become seriously ill. You may now state your health care preferences in writing, while you are still healthy and able to make such decisions prior to your heart transplant.
Cleveland Clinic is required by law to provide you, the patient, an explanation of your rights to make personal decisions regarding your own medical care. We also are required to ask you whether you have written down your wishes prior to your heart transplant.
The following explains your options concerning the right to accept or refuse medical treatment and how you may make your wishes known about the care you want when you are unable to decide for yourself. It is not legal advice, but it serves as general information to help you understand your rights prior to your heart transplant.
Q: What are my rights regarding medical treatment decisions?
You have the right to make your own medical treatment decisions. If you do not want certain treatments, you have the right to tell your doctor you do not want them. Most patients can express their wishes to their doctor, but some who are seriously injured or unconscious cannot. However, you have the right to make your wishes known before such a situation occurs, prior to your heart transplant.
Q: What if I'm too sick to decide or unable to communicate my wishes?
Sometimes people can't tell their doctor about the kind of care they want because they become too sick and are unable to communicate. Under Ohio law, you have the right to fill out a form, while you are still able, that tells your doctors what you want done if you are unable to communicate your wishes.
Q: What kinds of forms are available?
Under Ohio law, there are two different forms you can use to make your wishes known: durable power of attorney and living will. These documents are referred to as advance directives because they are signed in advance to let your doctor and others know your wishes concerning medical treatment.
- Durable Power of Attorney for Health Care: This form allows you to appoint someone as your agent to make all health care decisions for you, should you become terminally ill and unable to communicate, or temporarily or permanently unable to make decisions for yourself.
- Living Will: This form allows you to give advance written directions about all your health care decisions when you are terminally ill and unable to communicate or in a permanently unconscious state.
Q: Do I have to fill out these forms before I get medical care?
No person or health care provider can require you to fill out either of these forms. Completing one or both of these forms is a voluntary action on your part.
Q: Who can fill out the forms?
Anyone at least 18 years old who can make his or her own decisions can fill out these forms.
Q: Do I need a lawyer?
No, you don't need a lawyer to fill them out. You may choose to discuss these matters with an attorney, but there is no requirement to do so.
Q: Do my health care providers have to follow my instructions?
Yes, if your directions comply with state law. However, Ohio law includes a conscience clause in case your health care provider is unable to follow your directions because they are in conflict with the caregiver's conscience. In this case, you can be transferred to another health care provider who will comply with your wishes.
Durable Power of Attorney for Health Care
Q: Whom should I choose to make all my health care decisions for me if I am unable?
You can choose any adult relative or friend you trust to speak for you when you're unable to make your own decisions. Be sure you talk with that person about your decisions. Then write them down on a Durable Power of Attorney form. You should also talk to your doctor about your decisions.
Q: When is my Durable Power of Attorney in effect?
This document becomes in effect only when you are temporarily or permanently unable to make your own decisions about your treatment.
Q: What is the basic difference between a Durable Power of Attorney and a living will?
Your living will is your set of written instructions about the type of health care treatment you want when you are unable to communicate your wishes. Your Durable Power of Attorney allows you to choose a person to make your health care treatment decisions for you when you are unable to do so yourself.
Q: If I have a Durable Power of Attorney, do I need a living will too?
Many people will want to have both documents because they can address different aspects of your medical care. A living will gives your instructions directly to your doctors and a Durable Power of Attorney appoints a person you have chosen to make health care treatment decisions for you.
Q: How does a living will work?
It spells out to what extent you want life-support technology used to prolong your life. It gives your caregivers the authority to follow your instructions regarding the medical treatment you want under these conditions.
A Patient Without a Durable Power of Attorney or a Living Will
Q: If I don't have a living will or Durable Power of Attorney, who makes my health care decisions when I'm terminally ill and unable to communicate or in a permanently unconscious state?
Ohio law now recognizes an Order of Decision Makers when you are no longer able to make health care decisions for yourself. This Order of Decision Makers is very similar to the current legally recognized next-of-kin priority order. The law allows next of kin:
- To make all health care decisions if you are terminally ill and unable to communicate.
- To make decisions for the withdrawal of life support if you are in a permanently unconscious state only after a 12-month waiting period.
- However, this doesn't include the withdrawal of artificially supplied nutrition and hydration (food and water) except as explained below.
Other Matters to Consider
Q: What about the withholding of artificially supplied food and water?
Whether you can authorize the withholding of artificially supplied food and water (internal feeding tubes and fluid tubes) depends on your medical condition. If you are terminally ill and unable to communicate, and if your living will or Durable Power of Attorney simply states that you don't want life-support technology used to prolong your life, then artificially supplied food and water can be withheld.
If you are in a permanently unconscious state, artificially supplied food and water may be withheld only if you have written specific instructions about artificially supplied food and water in your living will of Durable Power of Attorney.
If you don't have either of these forms, Ohio law allows your next of kin to authorize the withholding of artificially supplied food and water when you are in a permanently unconscious state. Your next of kin can make those decisions for you only after a 12-month waiting period and approval from a probate court.
Q: Can I make changes to my forms?
Yes, at any time. If you already have a Durable Power of Attorney, it may be recognized under state law if the document is substantially in compliance with Ohio's law that took effect Oct. 10, 1991. Ohio law didn't formally recognize living wills until that date. It is always a good idea to be sure they still reflect your views, and your old forms may not cover specific areas.
Q: Where do I get living will and Durable Power of Attorney forms?
If you're interested in getting copies of these forms, ask your health care provider. Many hospitals and other health care organizations will make these forms available upon request.
Q: What do I do with my forms after filling them out?
You should give copies to your doctor and health care facility to put into your medical record. Be sure to tell your family, friends and people close to you about what you have done and consider giving them a copy as well. Do not simply put these documents in a "safe" place and forget about them.
Q: What if I need assistance?
If you desire to prepare a Living Will or Durable Power of Attorney for Health Care Decisions, or need assistance in making moral decisions during your stay with us, the Patient Information pamphlet describes resources to assist you that are available at the Cleveland Clinic.
The Cleveland Clinic has a Bioethics Department, a Hospital Ethics Committee, Pastoral Care Department, Ombudsman Office and Social Work Department. Members of these departments and offices are available to assist you both in preparing a living will or durable power of attorney and discussing moral or religious questions concerning your care.