Medical Directive Consultation Form
Medical Directives express your preferences for medical care in the event that you
cannot communicate your wishes, and it legally binds your healthcare providers to follow your orders.
You can specify what care you want provided or withheld if you are diagnosed to have a terminal illness
or to be in a permanent coma, and you can name an agent to ensure that your wishes are followed.
The following terms have special meaning when used in your healthcare Directive.
- Terminal condition means a condition that will cause imminent death, or to
a reasonable degree of medical certainty, is hopeless unless artificially supported through the use of
life-sustaining procedures. The condition must be confirmed by a physician who is qualified and experienced
in making such a diagnosis.
- Permanent coma means a condition that, to a reasonable degree of medical certainty:
will last permanently, without improvement, and
in which there is no cognitive thought, sensation, purposeful action, social interaction and awareness
of self and environment.
In addition, the condition must have existed for a period of time sufficient to make such a diagnosis,
and must be confirmed by a physician who is qualified and experienced in making such a diagnosis.
- Life-prolonging treatment means any medical treatment, procedure or intervention
that, in the judgment of the attending physicians, would only serve to prolong the dying process where
the patient has a terminal illness or injury, or would serve only to maintain the patient in a condition
of permanent unconsciousness. These procedures include assisted ventilation, cardiopulmonary resuscitation,
renal dialysis, surgical procedures, blood transfusions and the administration of drugs and antibiotics.
- Artificially administered food and water -- also called nutrition and hydration
-- means administering food and water through a tube or intravenous line, where the recipient is not required
to chew or swallow voluntarily.
- Comfort care means any care that doctors think is necessary to make a patient
comfortable or alleviate pain. It does not include artificially-administered food and water.
We need the following information to prepare your Medical Directive: