Advanced Directives and Bioethics
Upon admission to East Liverpool City Hospital, you or your family member
will be asked if you have made an advance directive. Advance directives
are legally valid, written documents to ensure that a person’s wishes
regarding medical treatment – especially the use of life-sustaining
treatment – are respected should they become unable to make and
communicate these wishes themselves. Living wills and durable powers of
attorney for healthcare are two types of advance directives, which are
well-defined and recognized under Ohio law.
As defined by Ohio law, a living will:
- becomes effective only when the person is permanently unconscious or terminally
ill and unable to communicate;
- states whether or not a person wishes life-sustaining technology to be
used to prolong his or her existence;
- states whether or not artificial feeding and hydration (water) are to be withheld;
- grants physicians authority to follow the instructions;
- can be revoked or changed by the patient at any time, either in writing
- gives information about anatomical gifts.
Durable Power of Attorney for Healthcare & Durable Power of Attorney
for Psychiatric Healthcare
Under another type of advance directive, call durable power of attorney
for healthcare, a person designates an individual to make health care
decisions should the person become unable to make these decisions him-
or herself. This attorney-in-fact could, for example, give or withhold
consent to perform surgery or other procedures, select or dismiss physicians,
order transfer to another medical facility, or approve a “comfort
measures only” order. The document designating health care power
of attorney can incorporate aspects of a living will by including specific
statements of the person’s wishes concerning the use of, for example,
ventilators, kidney dialysis, blood transfusions, artificial feeding and
The durable power of attorney for psychiatric healthcare can name a person
to make healthcare decisions and can designate medication wishes during
a psychiatric crisis.
How to Make an Advance Directive
ELCH will keep a copy of your advance directive on file as a permanent
part of your medical record. It is a good idea, however, to make arrangements
that, should something happen to you, copies of your advance directive
are given as soon as possible to ambulance workers, emergency room personnel
and your physician.
When a patient’s heart or breathing stops, it is hospital policy
and common medical practice to use cardiopulmonary resuscitation (CPR)
to attempt to save the patient’s life. CPR usually involves airway
resuscitation and chest compressions. Advanced CPR may involve electric
shock, opening the airway by inserting a tube, injection of medications
to restart the heart and, in extreme cases, open heart massage.
Patients wishing to receive all available resuscitation measures are said
to have a “full code” status. ELCH recognizes that not all
patients wish to be subjected to resuscitation measure. In accord with
Ohio law, a person wishing an alternative code status could choose either
“DNR Comfort Care Arrest (DNRCC-Arrest)” or “DNR Comfort
Care (DNRCC).” Your nurse, the hospital chaplain, a social worker
or a member of the bioethics consultation team can help you decide if
you desire to have a code status related to the withholding of resuscitation
measures and which is appropriate for you.
Comfort care code statuses are recognized as being medically and ethically
appropriate in circumstances such as when a patient has a terminal illness.
Competent patients have the right to request a comfort care code status
for themselves, or specify such a desire in an advance directive.
Patient Right to Decide
Adult patients who are mentally competent have the right to refuse or accept
any medical treatment, including life-sustaining treatment. In the case
of minors under the age of 18 (excepting those legally emancipated), the
wishes of parents or legal guardians will be followed unless there are
documented extenuating circumstances. In the case of adult patients who
have made advance directives, their wishes as thus communicated will be
followed should they lose the capacity to make their own decisions. In
the case of adult patients who have not made advance directives, health
care decisions are to be made by a surrogate (a guardian, spouse or near
relative) if they become incapacitated.
Hospital Rights & Policy
It is the policy of East Liverpool City Hospital to provide quality medical
care to its patients in conformity with traditional and current ethical
and medical standards, with the objective of sustaining life, preserving
health and easing pain and suffering. The hospital strives to preserve
patient dignity at all times and respects the legally defined rights of
patients and their families to participate in the bioethical decision-making process.
Physician Rights & Responsibilities
A physician may decline to participate in the limitation or withdrawal
of treatment from a patient. However, no physician may withdraw from providing
care for that patient until another physician has agreed to accept the
patient. It is the physician’s responsibility to inform a patient
and/or the family about therapeutic options and to thoroughly discuss
those options so that an informed decision may be made.
East Liverpool City Hospital maintains an active Bioethics Committee. Should
you have any questions regarding medical-ethical concerns, please do not
hesitate to request a meeting with a member of the Bioethics Consultation
Team. Simply asking your nurse or nurse supervisor for such a meeting
can do this.
Organ & Tissue Donation
Ohio law requires that all hospitals that receive Medicare or Medicaid
funding have a procedure in place to offer organ donation as an option
to families of potential donors. East Liverpool City Hospital provides
the option to consider such a donation. For every potential donor, the
patient’s family may be approached, at or near the time of death,
concerning the possibility of organ and tissue donation. Staff professionals,
who are specially trained to identify potential donors will make such
a request and work with families through the process. If you would like
more information, your nurse will help you contact one of these professionals.