Overview

Overview

What is Advance Care Planning?

Advance care planning refers to when people proactively think about what their healthcare wishes would be if they were unable to speak for themselves at any time in the future, and communicate those wishes to others. Advanced care planning is important for people of all ages because anything can happen to anyone at any time and having a plan in place can help ensure that your healthcare wishes can be known and honored in any situation.

A powerful tool to help let your medical team know your healthcare wishes is through an Advance Directive.

What is an advance directive?

Advance Directives are legal documents that provide instructions about your healthcare wishes, in case you are unable to speak for yourself.

There are two different types of Advance Directives, (1) a Health Care Power of Attorney and (2) a Living Will. A Health Care Power of Attorney is a type of Advance Directive in which you name a person to make decisions and speak for you when you are unable to speak for yourself and applies in nearly all circumstances. A Living Will is a written set of instructions regarding your preferences for healthcare and goes into effect if you are terminally ill and unable to make decision for yourself, or if you are permanently unconscious.

Cleveland Clinic recommends that every person over the age of 18 have an advance directive in their electronic medical record and have conversations with their loved ones about their wishes. We suggest using The Conversation Project to prepare for these conversations.

How can I complete an advance directive?

Any person over age 18 who can make his or her own decisions can complete an advance directive form. You do not need a lawyer to complete advance directive forms. However, the forms need to be signed by a notary or two witnesses. The witness may include anyone except your physician, family members, or the person(s) you’re naming as decision maker in the advance directives.

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What should I do with my completed advance directive documents?

After you complete the forms, you should talk to those people who may be involved in your healthcare decision making, and give them a copy of your forms to make sure that your wishes are followed. Remember to include loved ones, family members and your healthcare providers.

We encourage you to have a copy of your advance directives placed in your medical record at Cleveland Clinic. If you have completed a living will or health care power of attorney and have not had your documents scanned into the electronic medical record, please send a copy (include your name and date of birth on the form) via fax or mail to the address listed below.

By Mail

Cleveland Clinic
Health Information Management, Ab7
Advance Directive Processing
9500 Euclid Avenue
Cleveland, Ohio 44195-9905

By Fax

Fax your completed documents to:
Health Information Management
Advance Directive Processing
Fax Number: 216.445.9733

Additional Resources

Need help with Advance Directives?

Assistance for patients in completing Advance Directives is available from either:

Spiritual Care Department
216.444.2518

Care Management
216.444.3213

If you have questions about the applicability of Advance Directives, conflicts in their interpretation or implementation or about the withholding and withdrawing of life-sustaining treatment, contact:

Bioethics Department 
216.444.8720, Pager #22512

Ethics FAQs

Ethics FAQs

What is healthcare ethics?

Healthcare ethics refers to difficult decisions about medical treatments that involve moral principles, religious beliefs or professional guidelines. Healthcare ethics is a thoughtful exploration of how to act well and make morally good choices, based on beliefs and values about life, health, suffering and death.

What are common ethical questions relating to healthcare?

Generally, ethics questions arise when the right thing to do is not clear or when people disagree about what is best for a person who is ill. Examples include:

  • When should life-sustaining treatments like breathing machines or feeding tubes be started, continued or stopped?
  • What should family members and healthcare professionals do if a patient refuses treatment that promises to be medically helpful?
  • Who should make healthcare decisions for patients when they are unable to communicate or decide for themselves?
  • What should patients do when they do not understand what professionals are saying and feel they are not offered the opportunity to participate in their own healthcare decisions?

Who can help me make ethical healthcare decisions?

The Ethics Consultation Service is staffed by clinical bioethicists who are members of the Bioethics Department. Typically, the Ethics Consultation Service is able to respond quickly to requests for assistance.

The Ethics Consultation Service is primarily intended as a resource when patients, family members or health professionals may feel that they have reached the limits of their own personal or professional ability to address ethical questions.

The Cleveland Clinic Foundation offers this advisory service free to patients, family members and healthcare providers. The patient and anyone involved in caring for that patient can request an Ethics Consultation without fear of intimidation or reprisal. All discussions are confidential.

Some questions or issues necessitate the use of an ad hoc sub-committee of the CCF Ethics Committee. This sub-committee is convened for any of the following reasons:

  • The Chairman of the Ethics Committee (or designee) believes that the issues are sufficiently complex that a team composed of members of the Ethics Committee would be beneficial to advise about the issue.
  • The person requesting the Ethics Consultation believes that the issues are sufficiently complex that advice by members of the Ethics Committee would be beneficial.
  • Ethics Committee or CCF policy requires involvement of members of the Ethics Consultation.
  • External agencies request a formal analysis of or recommendation about a case.

What is an ethics consultation?

An Ethics Consultation is a process by which either trained consultants or an Ethics Consultation Sub-Committee of the Ethics Committee responds to requests for help to resolve ethical conflicts, issues, or questions involving patient care. An Ethics Consultation is advisory. Patients, family members, and healthcare providers remain responsible for their own decisions. Clarification of the ethically accepted course of action can help the healthcare providers and patients navigate difficult clinical circumstances.

When should an ethics consultation be requested?

An Ethics Consultation may be requested when an ethical problem or question involving patient care is not being satisfactorily addressed or resolved for all concerned. The Ethics Consultation is designed to support, not to replace normal lines of communication about ethically troubling situations.

Requests for help from the Ethics Consultation Service are encouraged in the following situations:

  • A patient, a family member or healthcare provider wants to "talk through" important ethical dimensions of the patients care.
  • Efforts by the patient, family and professional staff to resolve a problem have reached an impasse.
  • There is serious ethical disagreement among healthcare providers or within the patient/family relationship.
  • The case is ethically unusual, unprecedented or very complex.
  • In decisions about life-sustaining medical treatment for patients unable to decide for themselves.
  • In situations when communication or cooperation with the patients surrogate decision maker is compromised.
  • A patient, family member or healthcare provider needs help in facing an ethically significant decision.

What are some common ethical problems?

In general, an ethical problem exists when it is not clear what is the ethically sound action or course of action or when people disagree about what is best for a patient.

The following are some examples of ethical problems that can arise in the hospital:

  • What should a patient or surrogate do when he/she cannot understand what caregivers are saying, but tests and treatments continue anyway?
  • Who should make healthcare decisions when patients are unable to communicate or decide for themselves?
  • What should family members or caregivers do when they strongly disagree or are very uncertain about what is best for the patient?
  • When should life-prolonging treatments be started, continued or stopped?
  • What should family members and caregivers do when a patient refuses treatment that promises to be medically beneficial?

These and other ethical questions and concerns may develop to the point where conflict and serious disagreement results. Healthcare providers should rely on their education, experience and good judgment to prevent such escalation of disagreement. Discussing such situations with the Ethics Consultation Service might prove helpful before a true impasse is reached.

How is an ethics consultation requested?

Patients and family members can directly request an Ethics Consultation by calling the hospital operator and asking for the Ethics Consultation Service. They can also tell their nurse or healthcare provider that they want an Ethics Consultation.

Staff made aware of a patient or family desire for an Ethics Consultation shall convey the request to the Ethics Consultation Service.

During work hours, the Ethics Consultation Service can be reached by calling the Bioethics Department at 216.444.8720 or 4-8270. All other times use pager 2-2512.

Physicians or House staff may convey their request for an Ethics Consultation personally by telephone or by written orders in a patient's medical record, which shall be conveyed by the Nursing staff to the Ethics Consultation Service.

Nursing staff or other employees may request an Ethics Consultation directly or through their supervisor or manager who will initiate the consultation request.

The Ethics Consultant will notify the Attending Physician or their designee of the request for an Ethics Consultation.

Will my consultation with ethics professionals be confidential?

Yes. The deliberations and the proceedings of the Ethics Committee and the Department of Bioethics staff are strictly confidential.

Is the advice from an ethics consultation legally binding?

No. All recommendations from the Ethics Committee and the Department of Bioethics are advisory. An ethics consultation does not provide legally binding decisions for patients, families or professionals.

Is there a charge for an ethics consultation?

There are no fees for an ethics consultation, and you will not be billed for any ethics advice. Cleveland Clinic provides ethics consultations and other ethics resources as a service to patients, families and Cleveland Clinic professionals.

Which departments regularly review ethics issues?

The department provides Ethics Liaison Services to selected critical care units at Cleveland Clinic.

Surgical Intensive Care Unit

Weekly interdisciplinary team rounds are conducted to review ethical problems or issues arising in the care of patients.

Medical Intensive Care Unit

Patient care rounds are conducted with an interdisciplinary team led by Pulmonary Critical Care Fellows weekly to assist in the ethical management of patients with complex medical care needs and in communication with their families.

Monthly sessions are held with clinical-bedside nurses to address ethical issues and moral distress arising in the care of patients.

Neuro Intensive Care Unit

Patient care rounds are conducted with an interdisciplinary team led by a Neuro Intensivist or Fellow once a week to assist in the ethical management of patients with complex medical care needs and in communication with their families.

Cardio-Thoracic Intensive Care Unit

Weekly interdisciplinary team rounds are conducted to review ethical problems or issues arising in the care of patients.