What is an advance directive?
An advance directive states the health care
measures a person wants if he or she cannot indicate to continue curative or
life-sustaining treatment. An advance directive can also indicate if the person
wants to remove life support systems.
The person must develop
the advance directive while he or she is able to clearly and definitively
express himself or herself verbally, in writing, or in sign language. It must
express the person's own free will about his or her health care, not the will
of anyone else. It does not affect routine care for cleanliness and comfort.
This care must be given whether or not there is an advance directive.
Oregon law (ORS 127.505 to 127.660 and ORS 127.995) allows people to
preauthorize health care professionals to allow the natural dying process if
they are medically confirmed to be in one of the conditions described in their
health care instructions. The law does not authorize euthanasia, assisted
suicide, or any overt action to end their life.
Two adults must witness
or acknowledge the person signing the advance directive. At least one of the
two must not be related to the person by blood or marriage nor entitled to any
portion of the person's estate. The person's attending physician, attorney-in-fact,
and health care or residential staff may not serve as witnesses.
Health care instructions
These may either be
general or relate to the four specific conditions outlined below. However,
general instructions, such as the person never wishes to be placed on life
support, may be too vague. Also, it may not provide for a situation in which an
accident or emergency requires that the person temporarily be placed on life
support. Specific instructions about the person's wishes in each of the four scenarios
listed below are preferred. Some hospitals' social workers or chaplains will
provide instructions and forms for advance directives. The patient's physician
can determine if any of these four conditions apply:
- Close to death: Terminal
illness in which death is imminent with or without treatment, and where life
support will only postpone the moment of death.
- Permanently unconscious: Completely
lacking an awareness of self and external environment, with no reasonable
possibility of a return to a conscious state.
- Advanced progressive illness: A
progressive illness that will be fatal and is unlikely to improve.
- Extraordinary suffering: Illness
or condition in which life support will not improve the person's medical
condition and would cause the person permanent and severe pain.
representative: An advance
directive can appoint someone who is at least 18 years old to make medical
decisions for the person when he or she is not able to do so. Among the
decisions this health care representative can make is whether to withhold or
remove life support, food, or hydration. The health care representative and an
alternate must sign the document accepting their appointment. The patient
should appoint a health care representative that he or she trusts completely. A
patient can voluntarily revoke his or her appointment of a health care
representative at any time. A general Durable Power of Attorney, which is for
financial affairs, does not include authority to make health care decisions.
Special instructions and conditions: These
can be inserted into the health care plan or included for the health care
representative as long as they do not deal with the distribution of property.
Duration and changes: The
advance directive can be designated in effect for a limited period of time. If
not, it is in effect until the person revokes it in writing or dies. A person
can cross out words or add words to his or her advance directive to make it
better express his or her wishes.