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Advance Directive Information

Making an Advance Directive
 
What happens when an individual becomes too ill to make his or her own medical decisions? Someone must decide when to begin or not begin treatment, or when to stop it. Family members and doctors usually make decisions when the patient cannot. Sometimes they are not sure what is best. Sometimes they disagree. That's when it would be good to know what the patient would have wanted and whom the patient would have wanted to make these decisions. That's why it will help your family, close friends and physicians if you have completed an Advance Health Care Directive. If you have made your wishes clear, they are more likely to be followed.
 
What is an Advance Directive?
 
An Advance Health Care Directive is a verbal or written instruction that tells your family and health care team what you want done in case you have a serious injury or illness and are not able to speak for yourself.
 
For more information on Advance Directive, go to the Biller Resource Center to pick up the educational booklet Making an Advance Directive or ask to speak to a clinical Social Worker.
 
Benefits of completing an advance healthcare directive include:
 
  • Ensuring that your family, caregiver, friends and medical team are aware of your healthcare preferences
  • Allows you to determine your values, goals and quality of life
  • Ensures that your decisions are respected
  • Research shows that patients and their families report significantly less stress, anxiety and depression when an advance directive is in place
  • Frees your loved ones from the pressures of having to make critical medical care decisions for you under stressful or emotional situations.

Advance Directive - Resources

The Department of Supportive Care Medicine offers resources to help patients at any stage of illness navigate complex medical decisions. 
 
Notary Services for Advance Directives are available free of charge at the Sheri & Les Biller Patient and Family Resource Center by appointment.

During business hours, please contact the Sheri & Les Biller Patient and Family Resource Center.
 
Phone: 626-256-4673, ext. 32273 (3CARE)
BillerResourceCenter@coh.org
M-F, 8 a.m. to 5 p.m.
Fax:  626-256-8625
 
After hours and on weekends, you may contact any notary service at your expense.
 

Sheri & Les Biller Patient and Family Resource Center

  • Education and information on common health care decisions
  • Notary appointments
  • Advance Directive forms

Clinical Social Work

  • Arrange and participate in family meetings
  • Assistance with filling out Advance Directive form
  • Financial, estate and legal guardianship guidance
  • Bereavement support
  • Assistance with funeral arrangements

Spiritual Care

  • Can participate in family meetings
  • Clarification of values and priorities
  • Bereavement support

Pain and Palliative Medicine

  • Clarification of priorities and goals
  • Assistance with understanding common healthcare decisions
  • Communication of treatment preferences to family and medical team

Advance Directive - FAQs

What are advance health care directives?

Advance health care directives are written instructions to your loved ones and medical team about the type of medical treatment and health care that you would like to receive in the event that you are unable to speak directly with your health care providers.  Because these instructions are made before the medical treatment and health care is actually needed, they are often referred to as “Advance directives.”

What is a health care agent?

An agent is a relative or friend who you trust to make medical decisions for you if you cannot make them yourself.

Who should be my agent(s) for health care?

This is a very important question.  You should think very carefully about whom you want to be your agent. Whomever you decide to name as your agent under your durable power of attorney for health care, it should be someone you know very well.  It should also be someone you respect and someone whose judgment you value.  The person you name as your agent should be somewhat knowledgeable about medical issues, although it’s not necessary that this person have any medical training.  This person should also have a good understanding of who you are and what your values and wishes are.  After all, this person could be stepping into your shoes to make the very difficult medical decisions that you would have to make for yourself if you were able to do so.  This individual also has to be over the age of 18.

Can I name more than one agent to act (speak on my behalf) for me?

Yes.  You can appoint as many agents as you would like; however, if you appoint more than one agent, then you should specify whether each agent can act separately or whether they all must act together. There are advantages and disadvantages to having one or two agents.  Requiring your agents to act   together can safeguard the soundness of their decisions, but it may be difficult for them to come to an agreement on all decisions.  If any one of them can make decisions for you, that may be much easier to get things done, but it also may cause serious disagreements among them if they are not told in advance.  Another option is to appoint only one agent, with another named as an alternate in case the first named agent is unable to act for you.  Regardless of which option you choose, it is important to have conversations with each person before you appoint them as your agent to ensure that they are aware and in agreement with being your durable power of attorney for health care.

Where can I get the Advance Health Care Directive form at City of Hope?

You can ask your doctor, nurse or clinical social worker for the form or you can get a copy at the Sheri & Les Biller Patient and Family Resource Center at City of Hope.  You can also access it here and print the California version at www.cmanet.org.

Who can I talk to about an advance health care directive at City of Hope?

You are encouraged to discuss your advance health care needs with the doctor who is treating you and other members of your healthcare team that are involved in your care. The more medical staff you discuss this with the better informed you can be about how you want your medical care needs met. When completing the form you can ask your health care team for clarification in any area. The department of Supportive Care has many disciplines here to discuss this important matter with you. You can also schedule an appointment with your assigned social worker and get direction and guidance.

How does the form become valid?

• One or more of the sections is completed
• The form is signed and dated by you, the patient.
The form can be signed by another adult at the request of the patient and in the patient’s presence.
The form is properly witnessed
 
  • Your signature in Part 5 must be witnessed, by either two witnesses or notarized by a notary public. The witnesses can only include one blood relative and your power of attorney cannot serve as a witness or any City of Hope employee.
  • At City of Hope we have free notary services, you can arrange for an appointment by going to the Biller Patient and Family Resource center and request an appointment or by calling 626-256-HOPE (4673), ext. 3-CARE (32273). Your assigned social worker will be notified to review the document before it is notarized.

What do I do with the form when it is complete and validated?

  • Provide a copy to your agent(s) and keep one for yourself.
  • Provide a copy to Medical Records at City of Hope. It will be electronically attached to your medical record.
  • Provide a copy to all other medical facilities where you receive care.

How can I ensure that my values and goals will be honored?

California law requires that medical service providers honor your wishes regarding medical care and treatment.  However, conflicts sometimes arise when there is a lack of communication between medical service providers and family members.  This is another reason why you should communicate your wishes to your family members, your doctor and your health care team in addition to stating your wishes in the form of an advance health care directive as early as possible.

How long will my advance health care directive last?

There is no time limit for these documents.  Generally they will last until you change them or terminate them.  You may change them at any time and update the form from time to time by simply completing new documents.  It is always a good idea to destroy your old documents so that they aren’t confused with your new ones.  You may also terminate them at any time by:
  • Signing a written statement to that effect.
  • Destroying the original and all copies.
  • Telling at least two people that you are terminating them.
  • Completing a new advance health care directive.

What other kind of health care directives are there?

There are two other kinds of health care directives.  The first is called a “durable power of attorney for health care” or a “health care proxy.”  The second is called a “living will.”

Am I required to have both a durable power of attorney and a living will?

No.  You are not required to have any of these.  But, one or more of them is a good way to ensure that your wishes are known if you’re ever in a situation where you are unable to speak for yourself.  If your wishes are known, then your healthcare team will know what procedures to follow and your family and friends will be spared the agony of second-guessing what you would have wanted.

What is a durable power of attorney for health care?

A “durable power of attorney for health care” or “DPOA” is a legal document in which you name another person as your agent to make health care decisions for you in the event that you are unable to.  A durable power of attorney for health care pertains only to your health care decisions, not financial matters.  You can include instructions about the types of medical treatments you want or don’t want as well as information about your personal goals, values and preferences, where you want to receive care, instructions about artificial nutrition and hydration, etc.  You can be as general or as specific as you like because it is your directive to your designated agent(s).

What is a living will?

A living will is a legal document that states your preferences for medical treatment if you are terminally ill or permanently unconscious and unable to actively take part in making decisions for your own life.  Under a living will, you can state whether you want or don’t want certain life-sustaining procedures, including artificial respiration, cardiopulmonary resuscitation, and artificial means of providing nutrition and hydration.
 
The term “terminally ill” generally means that you have an incurable or irreversible medical condition that will result in death within a relatively short amount of time.  The term “permanently unconscious” generally means that you are in a permanent coma or a persistent vegetative state, which is an irreversible condition in which you are not aware of yourself or your environment and show no response to the environment.

Can I decide what treatment I want under a living will?

Yes.  That decision is entirely up to you.  But, it’s an important decision that should be discussed with your loved ones and your health care team.  Some people feel comfortable making a living will, while many others do not.  Talk with your doctor regarding your medical condition in addition to family and friends to determine what is best for you.
 
To discuss questions in regards to completing your advance health care directive, contact the Biller Patient and Family Resource Center at 626-256-HOPE (4673), ext. 3-CARE (32273). Your assigned social worker will then be notified to assist you.

Advance Directive

Advance Directive Information

Making an Advance Directive
 
What happens when an individual becomes too ill to make his or her own medical decisions? Someone must decide when to begin or not begin treatment, or when to stop it. Family members and doctors usually make decisions when the patient cannot. Sometimes they are not sure what is best. Sometimes they disagree. That's when it would be good to know what the patient would have wanted and whom the patient would have wanted to make these decisions. That's why it will help your family, close friends and physicians if you have completed an Advance Health Care Directive. If you have made your wishes clear, they are more likely to be followed.
 
What is an Advance Directive?
 
An Advance Health Care Directive is a verbal or written instruction that tells your family and health care team what you want done in case you have a serious injury or illness and are not able to speak for yourself.
 
For more information on Advance Directive, go to the Biller Resource Center to pick up the educational booklet Making an Advance Directive or ask to speak to a clinical Social Worker.
 
Benefits of completing an advance healthcare directive include:
 
  • Ensuring that your family, caregiver, friends and medical team are aware of your healthcare preferences
  • Allows you to determine your values, goals and quality of life
  • Ensures that your decisions are respected
  • Research shows that patients and their families report significantly less stress, anxiety and depression when an advance directive is in place
  • Frees your loved ones from the pressures of having to make critical medical care decisions for you under stressful or emotional situations.

Resources

Advance Directive - Resources

The Department of Supportive Care Medicine offers resources to help patients at any stage of illness navigate complex medical decisions. 
 
Notary Services for Advance Directives are available free of charge at the Sheri & Les Biller Patient and Family Resource Center by appointment.

During business hours, please contact the Sheri & Les Biller Patient and Family Resource Center.
 
Phone: 626-256-4673, ext. 32273 (3CARE)
BillerResourceCenter@coh.org
M-F, 8 a.m. to 5 p.m.
Fax:  626-256-8625
 
After hours and on weekends, you may contact any notary service at your expense.
 

Sheri & Les Biller Patient and Family Resource Center

  • Education and information on common health care decisions
  • Notary appointments
  • Advance Directive forms

Clinical Social Work

  • Arrange and participate in family meetings
  • Assistance with filling out Advance Directive form
  • Financial, estate and legal guardianship guidance
  • Bereavement support
  • Assistance with funeral arrangements

Spiritual Care

  • Can participate in family meetings
  • Clarification of values and priorities
  • Bereavement support

Pain and Palliative Medicine

  • Clarification of priorities and goals
  • Assistance with understanding common healthcare decisions
  • Communication of treatment preferences to family and medical team

FAQs

Advance Directive - FAQs

What are advance health care directives?

Advance health care directives are written instructions to your loved ones and medical team about the type of medical treatment and health care that you would like to receive in the event that you are unable to speak directly with your health care providers.  Because these instructions are made before the medical treatment and health care is actually needed, they are often referred to as “Advance directives.”

What is a health care agent?

An agent is a relative or friend who you trust to make medical decisions for you if you cannot make them yourself.

Who should be my agent(s) for health care?

This is a very important question.  You should think very carefully about whom you want to be your agent. Whomever you decide to name as your agent under your durable power of attorney for health care, it should be someone you know very well.  It should also be someone you respect and someone whose judgment you value.  The person you name as your agent should be somewhat knowledgeable about medical issues, although it’s not necessary that this person have any medical training.  This person should also have a good understanding of who you are and what your values and wishes are.  After all, this person could be stepping into your shoes to make the very difficult medical decisions that you would have to make for yourself if you were able to do so.  This individual also has to be over the age of 18.

Can I name more than one agent to act (speak on my behalf) for me?

Yes.  You can appoint as many agents as you would like; however, if you appoint more than one agent, then you should specify whether each agent can act separately or whether they all must act together. There are advantages and disadvantages to having one or two agents.  Requiring your agents to act   together can safeguard the soundness of their decisions, but it may be difficult for them to come to an agreement on all decisions.  If any one of them can make decisions for you, that may be much easier to get things done, but it also may cause serious disagreements among them if they are not told in advance.  Another option is to appoint only one agent, with another named as an alternate in case the first named agent is unable to act for you.  Regardless of which option you choose, it is important to have conversations with each person before you appoint them as your agent to ensure that they are aware and in agreement with being your durable power of attorney for health care.

Where can I get the Advance Health Care Directive form at City of Hope?

You can ask your doctor, nurse or clinical social worker for the form or you can get a copy at the Sheri & Les Biller Patient and Family Resource Center at City of Hope.  You can also access it here and print the California version at www.cmanet.org.

Who can I talk to about an advance health care directive at City of Hope?

You are encouraged to discuss your advance health care needs with the doctor who is treating you and other members of your healthcare team that are involved in your care. The more medical staff you discuss this with the better informed you can be about how you want your medical care needs met. When completing the form you can ask your health care team for clarification in any area. The department of Supportive Care has many disciplines here to discuss this important matter with you. You can also schedule an appointment with your assigned social worker and get direction and guidance.

How does the form become valid?

• One or more of the sections is completed
• The form is signed and dated by you, the patient.
The form can be signed by another adult at the request of the patient and in the patient’s presence.
The form is properly witnessed
 
  • Your signature in Part 5 must be witnessed, by either two witnesses or notarized by a notary public. The witnesses can only include one blood relative and your power of attorney cannot serve as a witness or any City of Hope employee.
  • At City of Hope we have free notary services, you can arrange for an appointment by going to the Biller Patient and Family Resource center and request an appointment or by calling 626-256-HOPE (4673), ext. 3-CARE (32273). Your assigned social worker will be notified to review the document before it is notarized.

What do I do with the form when it is complete and validated?

  • Provide a copy to your agent(s) and keep one for yourself.
  • Provide a copy to Medical Records at City of Hope. It will be electronically attached to your medical record.
  • Provide a copy to all other medical facilities where you receive care.

How can I ensure that my values and goals will be honored?

California law requires that medical service providers honor your wishes regarding medical care and treatment.  However, conflicts sometimes arise when there is a lack of communication between medical service providers and family members.  This is another reason why you should communicate your wishes to your family members, your doctor and your health care team in addition to stating your wishes in the form of an advance health care directive as early as possible.

How long will my advance health care directive last?

There is no time limit for these documents.  Generally they will last until you change them or terminate them.  You may change them at any time and update the form from time to time by simply completing new documents.  It is always a good idea to destroy your old documents so that they aren’t confused with your new ones.  You may also terminate them at any time by:
  • Signing a written statement to that effect.
  • Destroying the original and all copies.
  • Telling at least two people that you are terminating them.
  • Completing a new advance health care directive.

What other kind of health care directives are there?

There are two other kinds of health care directives.  The first is called a “durable power of attorney for health care” or a “health care proxy.”  The second is called a “living will.”

Am I required to have both a durable power of attorney and a living will?

No.  You are not required to have any of these.  But, one or more of them is a good way to ensure that your wishes are known if you’re ever in a situation where you are unable to speak for yourself.  If your wishes are known, then your healthcare team will know what procedures to follow and your family and friends will be spared the agony of second-guessing what you would have wanted.

What is a durable power of attorney for health care?

A “durable power of attorney for health care” or “DPOA” is a legal document in which you name another person as your agent to make health care decisions for you in the event that you are unable to.  A durable power of attorney for health care pertains only to your health care decisions, not financial matters.  You can include instructions about the types of medical treatments you want or don’t want as well as information about your personal goals, values and preferences, where you want to receive care, instructions about artificial nutrition and hydration, etc.  You can be as general or as specific as you like because it is your directive to your designated agent(s).

What is a living will?

A living will is a legal document that states your preferences for medical treatment if you are terminally ill or permanently unconscious and unable to actively take part in making decisions for your own life.  Under a living will, you can state whether you want or don’t want certain life-sustaining procedures, including artificial respiration, cardiopulmonary resuscitation, and artificial means of providing nutrition and hydration.
 
The term “terminally ill” generally means that you have an incurable or irreversible medical condition that will result in death within a relatively short amount of time.  The term “permanently unconscious” generally means that you are in a permanent coma or a persistent vegetative state, which is an irreversible condition in which you are not aware of yourself or your environment and show no response to the environment.

Can I decide what treatment I want under a living will?

Yes.  That decision is entirely up to you.  But, it’s an important decision that should be discussed with your loved ones and your health care team.  Some people feel comfortable making a living will, while many others do not.  Talk with your doctor regarding your medical condition in addition to family and friends to determine what is best for you.
 
To discuss questions in regards to completing your advance health care directive, contact the Biller Patient and Family Resource Center at 626-256-HOPE (4673), ext. 3-CARE (32273). Your assigned social worker will then be notified to assist you.
Making an Advance Directive
 
Watch this video to learn more about the importance of making an advance directive.
Advance Directive Video for healthcare providers
 
Watch City of Hope care providers discuss how having an advance directive helps to ensure  that patients’ goals through their illness are honored, so that their healthcare team can most effectively serve them.
 
 
Read this guide to learn more about how to make an advance healthcare directive. 
Advance Directive Forms
Below are the Advance Healthcare Directive forms:
 
If you have additional questions about Advance Directives, please contact us.
 
Phone: 626-256-4673, ext. 32273 (3CARE)
BillerResourceCenter@coh.org
M-F, 8 a.m. to 5 p.m.
Fax:  626-256-8625
City of Hope’s main hospital is located in Duarte, Calif., just northeast of Los Angeles, with community clinics in southern California.
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