Advance Health Care Directive: Frequently Asked Questions
St. Joseph Health, Sonoma County is committed to caring for the entire
person through every stage of life. We know that you may have some questions
before, during, and after you complete your advance health care directive,
so we created a list of frequently asked questions. Your primary care
provider is also a valuable resource and will gladly clarify or answer
any other questions you may have.
Who decides my treatment?
Your doctors will give you information and advice about treatment. You
have the right to choose. You can say "Yes" to treatments you want. You
can say "No" to any treatment that you don't want - even if the treatment
might keep you alive longer.
How do i know what I want?
Your doctor must tell you about your medical condition and about what different
treatments and pain management alternatives can do for you. Many treatments
have "side effects." Your doctor must offer you information about problems
that medical treatment is likely to cause you. Often, more than one treatment
might help you - and people have different ideas about which is best.
Your doctor can tell you which treatments are available to you, but your
doctor can't choose for you. That choice is yours to make and depends
on what is important to you.
Can other people help with my decisions?
Yes. Patients often turn to their relatives and close friends for help
in making medical decisions. These people can help you think about the
choices you face. You can ask the doctors and nurses to talk with your
relatives and friends. They can ask the doctors and nurses questions for you.
Can I choose a relative or friend to make health care decisions for me?
Yes. You may tell your doctor that you want someone else to make healthcare
decisions for you. Ask the doctor to list that person as your health care
"surrogate" in your medical record. The surrogate's control over your
medical decisions is effective only during treatment for your current
illness or injury or, if you are in a medical facility, until you leave
What if I become too sick to make my own health care decisions?
If you haven't named a surrogate, your doctor will ask your closest available
relative or friend to help decide what is best for you. Most of the time
that works. But sometimes everyone doesn't agree about what to do. That's
why it is helpful if you can say in advance what you want to happen if
you cannot speak for yourself.
Do I have to wait until I am sick to express my wishes about health care?
No. In fact, it is better to choose before you get very sick or have to
go into a hospital, nursing home, or other healthcare facility. You can
use an Advance Health Care Directive to say who you want to speak for
you and what kind of treatments you want. These documents are called "advance"
because you prepare one before healthcare decisions need to be made. They
are called "directives" because they state who will speak on your behalf
and what should be done.
In California, the part of an advance directive you can use to appoint
an agent to make healthcare decisions is called a Power of Attorney For
Health Care. The part where you can express what you want done is called
an Individual Health Care Instruction.
Who can make an advance directive?
You can if you are 18 years or older and are capable of making your own
medical decisions. You do not need a lawyer.
Who can I name as my agent?
You can choose an adult relative or any other person you trust to speak
for you when medical decisions must be made.
When does my agent begin making medical decisions?
Usually, a healthcare agent will make decisions only after you lose the
ability to make them yourself. But, if you wish, you can state in the
Power of Attorney for Health Care that you want the agent to begin making
How does my agent know what I would want?
After you choose your agent, talk to that person about what you want. Sometimes
treatment decisions are hard to make, and it truly helps if your agent
knows what you want. You can also write your wishes down in your advance
What if I don't want to name an agent?
You can still write out your wishes in your advance directive, without
naming an agent. You can say that you want to have your life continued
as long as possible. Or you can say that you would not want treatment
to continue your life. Also, you can express your wishes about the use
of pain relief or any other type of medical treatment.
Even if you have not filled out a written Individual Health Care Instruction,
you can discuss your wishes with your doctor, and ask your doctor to list
those wishes in your medical record. Or you can discuss our wishes with
your family members or friends. But it will probably be easier to follow
your wishes if you write them down.
What is I change my mind?
You can change or cancel your advance directive at any time as long as
you can communicate your wishes. To change the person you want to make
your healthcare decisions, you must sign a statement or tell the doctor
in charge of your care.
What happens if someone else makes decisions about my treatment?
The same rules apply to anyone who makes healthcare decisions on your behalf
- a healthcare agent, a surrogate whose name you gave to your doctor,
or a person appointed by a court to make decisions for you. All are required
to follow your Health Care Instructions or, if none, your general wishes
about treatment, including stopping treatment. If your treatment wishes
are not known, the surrogate must try to determine what is in your best interest.
The people providing your health care must follow the decisions of your
agent or surrogate unless a requested treatment would be bad medical practice
or ineffective in helping you. If this causes disagreement that cannot
be worked out, the provider must make a reasonable effort to find another
healthcare provider to take over your treatment.
Will I still be treated is I don't make an advance directive?
Absolutely, you will still get medical treatment. We just want you to know
that if you become too sick to make decisions, someone else will have
to make them for you.
Remember that: A Power of Attorney For Health Care lets you name an agent
to make decisions for you. Your agent can make most medical decisions
- not just those about life-sustaining treatment - when you can't speak
for yourself. You can also let your agent make decisions earlier, if you wish.
You can create an Individual Healthcare Instruction by writing down your
wishes about health care or by talking with your doctor and asking the
doctor to record your wishes in your medical file. If you know when you
would or would not want certain types of treatment, an Instruction provides
a good way to make your wishes clear to your doctor and to anyone else
who may be involved in deciding about treatment on your behalf. These
two types of Advance Healthcare Directives may be used together or separately.
How can I get more information about making an advance directive?
Ask your doctor, nurse, social worker, or healthcare provider to get more
information for you. You can have a lawyer write an advance directive
for you, or you can complete an Advance Health Care Directive by filling
in the blanks on a form.
The preceding text was prepared by the Pacific Center for Health Policy
and Ethics. Healthcare organizations must distribute this state-mandated
information to all patients (clients, residents, members) covered by the
Federal Patient Self- Determination Act to meet Medicare requirements
and JCAHO standards.
All of us at St. Joseph Health want our patients to understand their rights
to make medical treatment decisions.
St. Joseph Health complies with California laws and court decisions on
advance directives. We do not condition the provision of care or otherwise
discriminate against anyone based on whether or not an advance directive
has been executed. We have formal policies to ensure that your wishes
about treatment will be followed. We also have an Ethics Forum that can
help if any questions arise about your treatment wishes.
It is your responsibility to provide a copy of your advance directive to
the hospital so that it can be kept with your records. If you have any
questions about any of these forms, please talk to your doctor, your nurse,
or a member of the
Spiritual Care Department at ext. 6105.
Complaints concerning the advance directive requirements may be filed with
the State of California at the address below.