1. Oklahoma’s Advance Directives Linda Edmondson, LCSW

2. First, the Advance Directive for Health Care In the introduction: “If I am incapable of making an informed decision regarding my health care, I direct my health care providers to follow my instructions below.” Two physicians must determine the incapacity

3. The Advance Directive for Health Care has two parts-- The first is the “living will” with instructions for end-of-life care The second names a “health care proxy” to speak on the patient’s behalf

4. In the living will section... There are three end-of-life conditions— 1. Terminally ill (within 6 months) 2. Persistently unconscious (New--) 3. An end-stage condition

5. End-Stage Condition “…caused by injury, disease, or illness, which results in severe and permanent deterioration indicated by incompentency and complete physical dependency for which treatment of the irreversible condition would be medically ineffective…”

6. Three choices for each condition No life-sustaining treatment except tube feeding No life-sustaining treatment including tube feeding (New) I direct that I be given life-sustaining treatment and tube feeding

7. Blank lines Add instructions about other conditions when treatment is desired or refused Make specific comments about tube feeding, antibiotics, dialysis, pain medications, hospice care, etc.

8. The Health Care Proxy The proxy is “…authorized to make whatever medical treatment decisions I could make if I were able, except that decisions regarding life-sustaining treatment and artificially administered nutrition and hydration can only be made as I have directed…” Two physicians must determine incapacity

9. Proxy has added powers With the recent changes in the law and form, the health care proxy can make other health care decisions, for instance…. Hospice care Nursing home choice Consent for surgery

10. Choosing a proxy Name a trusted relative as proxy Consider naming an alternate in younger generation Add identifying information and contact numbers Talk to the proxy about your wishes

11. Remember The proxy can only make life-sustaining treatment decisions following the wishes outlined in the first sections of the Advance Directive

12. Anatomical Gifts For transplantation therapy Or Medical science, research or education

13. General Provisions Must be 18 years old to complete Witnesses must be 18 and not relatives or inheritors In effect during pregnancy only if clarified in patient’s own words

14. Can be easily revoked Takes precedence over earlier documents Copies should be given to proxy, other family, health care providers, etc.

15. Review Four Recent Major Changes: In effect any time patient is incapacitated End-of-life conditions now include an “end-stage condition” Clear choices about artificial nutrition and hydration are given Powers of the health care proxy are expanded

16. Complete a new document The added powers of the new law and form are so important... Complete a new one for yourself Begin to help your clients and patients complete a new document

17. Important to remember: So long as the patient has the capacity to make decisions, the Advance Directive is not in use.

18. Important to remember: The health care proxy can make ALL health care decisions ANY TIME the patient is incapacitated and unable to make decisions for himself or herself. Except...

19. ... End-of-life decisions The health care proxy can only make end- of-life decisions as outlined in the document And...

20. End-of-life Decisions After two physicians have determined that the patient is --Terminally ill (expected to die within six months)OR --Persistently unconscious (persistent vegetative state)OR --In an end-stage condition

21. Another Advance Directive: Durable Power of Attorney Most attorneys agree that a Durable Power of Attorney for Health Care is no longer needed for most people

22. Another Advance Directive: The Do-Not-Resuscitate Order Goes into effect immediately Is a near-death document Can be signed by the patient, the health care proxy, the agent of a durable power of attorney for health care, or a guardian Transfers and remains in effect wherever the patient is located

23. The Do-Not-Resuscitate Order On the other side the physician can sign Physician must know that the patient did not want CPR in the circumstances

24. Hydration and Nutrition for Incompetent Patients Act Very restrictive Assumes all incapacitated patients want tube feeding Exceptions are very narrow So it is very important to make your wishes known about tube feeding

25. Hierarchy of decision-makers There is no law in Oklahoma outlining the hierarachy of decision-makers if a patient is incapacitated and has left no instructions for end-of-life care.

26. Questions? Contact information: Linda Edmondson, LCSW LLEOKC@aol.com 405-771-5556