Going one step further
Going one step further
Patients at Gunderson Lutheran Medical Center in LaCross, WI, can't argue they're uninformed about advance directives. That's because the hospital implemented a comprehensive program to guide patients through the process of completing an advance directive.
During admission, patients receive a package called "Respecting Your Choices," which contains an information manual and the following items:
o a customized card with information on the institution;
o a booklet answering commonly asked questions;
o a worksheet with thought-provoking personal questions;
o a "Respecting Your Choices" video;
o a document title page for state-specific documents;
o a document sleeve made of easily visible, transparent fluorescent-green plastic;
o an advance directive record for physicians;
o a patient wallet card on advance directives.
After a thorough study of the booklets, the video, and the accompanying information, the patient and family may decide on such vital questions as the removal of ventilators and feeding tubes, denial of resuscitation efforts, emergency surgery, or drug therapy. Patients also must execute a power-of-attorney or designate a specific person to act as a care proxy or a legal representative, in case of incapacitation.
To avoid unpleasant surprises, patients are advised to discuss their choice with their prospective guardian or surrogate agent, says Bernard Hammes, director of medical humanities at the facility. Gundersen Medical Center patients are encouraged to include not only their families and medical caregivers in these decisions, but also their religious advisors or spiritual guides.
"These end-of-life decisions are not a decision, in the literal sense of the word, but rather a process that requires appropriate thought and study," says Hammes. This process should begin before there is a serious illness, an emergency, or the patient requires around-the-clock care or life-assistance.
At Gundersen, the gist of the educational program on advance directives is designed for the patient and his family. Though the material is made available to doctors' offices, hospitals, nursing homes, home care agencies, and public libraries, caregivers are merely instructed through written material and videos.
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