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Advance Directives and Appointing Health Care Representatives

As a patient at Oregon State Hospital, you have a legal right to complete an advance directive if you “have capacity.” Having capacity means that a court, your physician, or your psychiatric mental health nurse practitioner (PMHNP) has determined you can make and communicate health care decisions to medical providers.

Advance directives are written instructions – such as a living will – that outline your wishes for health care in the event you are incapacitated. This includes end-of-life medical care and mental health care decisions. These are your expressed wishes; however, court orders, Oregon Revised Statutes and Oregon Administrative Rules may override your wishes while you are in the hospital.
  • If you have capacity, the hospital may not limit your right to complete an advance directive.
  • Hospital staff must provide you with an opportunity to complete an advance directive, including a declaration for mental health treatment.
  • The hospital will honor your right to complete an advance directive and to review and revise your advance directive.
  • If you need help completing or updating an advance directive, hospital staff will arrange for assistance.
  • When people have capacity and complete their advanced directive, they may appoint someone as their Health Care Representative (HCR).
 
Health care representatives are given temporary authority to make medication decisions for people when they don’t have capacity to make decisions for themselves. Once individuals regain capacity, the representative will no longer have authority to make decisions on another’s behalf – unless the individual signs a Release of Information Form (MSC 2099) to allow this.
 
For someone to become a health care representative:
  • People must have capacity at the time they complete the Advanced Directive form.
  • OSH staff must review and validate the form.
  • The health care representative must agree to serve in this role, which essentially gives them the same decision-making authority of a guardian.
 
Please know that court orders, Oregon Revised Statutes and Oregon Administrative Rules may override the decision-making ability of both a guardian and a health care representative
For example:
  • Neither a guardian nor a health care representative can require a physician to order medication or care that the physician does not believe is appropriate.
  • Neither a guardian nor a health care representative can require OSH to keep a patient hospitalized after clinical staff determine hospital-level of care is no longer needed.
 
Oregon State Hospital will make every effort to respect your wishes concerning advance directives. For more information, please ask staff for a copy of Policy 6.025 on advance directives.

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