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.

Living Wills

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 or orally;
  • 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 hydration.

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.

Comfort Care

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.

Bioethics Issues

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.