If you aren’t sure whether your advance directive and health care power of attorney are on file at the hospital where you are being treated, ask. Also verify, if you have created multiple versions over time, that the one on file is the most recent.
Jill Logan, RN, Director of Ethics at Yavapai Regional Medical Center, explains how to make known to doctors and nurses in the hospital your wishes and preferences for care.
“For each hospital admission, the RN will ask if the patient has an advance directive and also check to see that a copy is available in the medical record. . .For patients admitted to the hospital, the physician will clarify the patient’s goals for resuscitation status on each admission.”
Do Not Resuscitate (DNR) orders do not carry over from one hospital admission to the next, so for people who do not wish to be revived if their heart or breathing stops, this conversation does in fact need to happen with every hospital admission.
Be aware that doctors and nurses are likely to rely more on what you tell them than on what your advance directive says. This fact can be useful to you. For example, suppose that you completed an advance directive many years ago. Your conclusions about the care you want may have changed, and by going directly to the source (you), they will have your up-to-the-minute thinking.
Thus, if they ask you questions about what you want, resist the temptation to say something like, “Oh, whatever,” and go back to sleep, assuming that they will follow the instructions in your advance directive. They may not, because you have just created uncertainty about what you want, and the health care system is set up to default to aggressive treatment in the absence of clear instructions to the contrary.
Also resist the tendency to reply in socially customary but dangerously irrelevant ways when they ask you questions. For example, if your doctor says, “How are you today?” when you’ve just had major surgery the previous day and are in severe pain, resist the inclination to automatically respond, “Fine, thanks, Doc. How are you?” The doctor may very well make decisions about your care based on your responses, and these decisions could be dangerous to you if you have not provided accurate information.
If you aren’t feeling mentally alert, it is fine to say, “Please ask my wife [or whoever is named as your health care representative] to make any decisions about my care today that you would normally ask me to make.”
By communicating clearly and repeatedly to make your wishes known, you increase the odds that you will get the care you want.
