VA 1.2:R 44 "Caring For Those Who Cared For America " Denver Department of Veterans Affairs Your Right To Decide Advance Directives (Living Will, Durable Power of Attorney for Health Care and Treatment Preference) Organ and Tissue Donation ADVANCE DIRECTIVES INFORMATION WE WANT YOU TO KNOW: • You have the right to make decisions about your health care. • You have the right to accept or refuse medical treatment. • You have the right to make an advance directive, such as a living will. In order to be sure that we do what you wish, it is important that we know in advance what you want done. WHAT IS AN ADVANCE DIRECTIVE? An advance directive is a way to say what you want done about your health care if you can no longer decide for yourself. An advance directive can take many forms. You can discuss your concerns with your doctor, nurse, or social worker. Your decision will be written in your medical record. You should also fill out a form which gives us legal authority to carry out your wishes. The VA has three kinds of legal forms which can be used. They are: • VA Living Will/VA Advance Directive • VA Durable Power of Attorney for Health Care • Treatment Preference Form Each form serves a different purpose on your behalf. The completion of only one form may not reflect all your decisions. VA LIVING WILL/ VA ADVANCE DIRECTIVE This is a form which states what you want done if you develop a terminal illness. A terminal illness is one in which there is no cure and in which death is expected within a period of six months. This form tells us your wishes about life-sustaining care. This care includes: • Heart and lung resuscitation (CPR) CPR involves pressing on the chest to restore blood flow once the heart has stopped beating and putting air into the lungs to give you oxygen. It has also been called “mouth to mouth resuscitation”. • Mechanical ventilation The placement of a tube down your throat and into your lungs. The tube is attached to a machine that helps you breathe. • Dialysis The cleansing of the blood by a machine when the kidneys fail. • Artificial Nutrition Feedings given through the veins or through a tube into the stomach. • Artificial Hydration Fluids given through the veins. The major problem with the Living Will is that it only applies to patients with terminal illness. If you are in a coma, you could live longer than six months. This would not be considered a terminal illness. In this case, it would be best also to have filled out a Durable Power of Attorney for Health Care or a VA Treatment Preference Form. VA DURABLE POWER OF ATTORNEY FOR HEALTH CARE This form allows you to pick someone to make decisions about your health care if you cannot do so yourself. This person is called a health care agent. You may pick anyone for your health care agent. Most patients will pick their spouse or another member of their family. You should pick someone you trust. It is important for you to talk to your health care agent and tell her or him what you want done. TREATMENT PREFERENCE FORM You can also complete a Treatment Preference form which can be used with a Living Will and a Durable Power of Attorney for Health Care. This form describes some situations which can occur such as brain damage or coma. When you complete this form it helps your doctor or health care agent know what treatment you want in each situation. FILLING OUT FORMS You do not need a lawyer to complete these forms. Each form you fill out must be witnessed by two people. Witnesses can be: • a neighbor • a friend • a member of another patient’s family If none of these people are available, the following hospital staff may be willing to be a witness: • a chaplain • a social worker • a clerk The following cannot be witnesses: • a member of your family • anyone paying your medical bills • anyone who may inherit your estate • hospital staff who directly take care of you such as doctors or nurses When you do fill out the forms, it is important to make some copies for your doctor, family and/or friends. It is very important for your health care agent to have a copy. CARRYING OUT YOUR WISHES Once you have made these important decisions, we want to make sure that they are carried out. We will note on your chart and in the Medical Center computer system that you have “Advance Directives”. You can change your mind at any time regarding your decisions for treatment. New forms will need to be filled out. Please let us know if you make any changes so that we can update our records. If you have any questions, please talk to your doctor, nurse, social worker or chaplain. ORGAN AND TISSUE DONATION INFORMATION IT’S WORTH A FAMILY DISCUSSION Deciding to be an organ or tissue donor can be hard if you don’t know the facts. This section will help you and your family make an informed decision. Even though the Denver VA Medical Center supports organ and tissue donation, your decision one way or the other won’t affect your care. After each death, the family is given the option of donation. When your family knows your wishes, it makes it easier for them. Please take a little time with your family to talk about donation - - it’s worth a family discussion. ANSWERS TO COMMON QUESTIONS: • Who can be a donor? Almost everyone can become a donor, regardless of age or medical history. If you want to become a donor, talk it over with your family and sign a Uniform Donor Card. At the time of death, your family will get help from a doctor or nurse when deciding what to donate. • Will signing a Uniform Donor Card affect the medical care you get at the V.A. Medical Center? If you are injured or ill, Medical Center staff will still give you the best possible care. Their main goal is to restore your health. Your family will not be asked about donation until every effort to save your life has been exhausted. • Will other veterans be helped when I donate? Yes, veterans get donations, but the organ or tissues you donate may not go to a veteran. Blood and tissue type, size and age must be matched to the person who gets the donation. Race and social status are never an issue. There is a long waiting list of people, some of them veterans, who need donations. • Will donation delay or change funeral plans? No. Organs or tissues are removed immediately after death with the utmost care and respect. If the family chooses, they can have an open casket funeral. • Is there a cost for donation? No. Family members don’t have to pay for anything except the funeral costs. • Will my religion allow me to donate my organs or tissues? All major religions support organ and issue donation. If you have any questions, please contact your clergy. • What organs and tissues can be donated? Life-saving organs that can be donated are hearts, lungs, livers, pancreas’ and kidneys. Some of the tissues that can be donated are corneas, bones, skin, cartilage and veins. TWO SIMPLE STEPS TO BECOMING A DONOR 4 1. Talk to your family about organ and tissue donation. This may seem difficult now, but think of how much easier it will be for your family when they are making these decisions. 2. Complete and sign the Uniform Donor Card found on the back of your driver’s license or in this booklet. When you sign the card, be sure to have your signature witnessed by two people. If you do these two things, you and your family’s wishes about donation will be respected. Deciding to be a donor is an important decision that concerns your entire family and could help many people. Please give it the serious thought it deserves. For more information call the Colorado Central Donation Information number, ( 303 ) 321 - 0060 . UNIFORM DONOR CARD Print or Type Name of Donor In the hope that I may help others, I hereby make this anatomical gift, if medically acceptable, to take effect upon my death. The words and marks below indicate my wishes. I give (a)_any needed tissues or organs (b)_only the following tissues or organs Specify the tissue(s) or organ(s) for purposes of transplantation, therapy, medical research or education; (c)_my body for anatomical study if needed. Limitations or special wishes, if any:_ CUT HERE UNIFORM DONOR CARD Print or Type Name of Donor In the hope that I may help others, I hereby make this anatomical gift, if medically acceptable, to take effect upon my death. The words and marks below indicate my wishes. I give (a)_any needed tissues or organs (b)_only the following tissues or organs cut here I - 1 - Specify the tissue(s) or organ(s) for purposes of transplantation, therapy, medical research or education; (c)_my body for anatomical study if needed. Limitations or special wishes, if any:_ UNIFORM DONOR CARD Print or Type Name of Donor In the hope that I may help others, I hereby make this anatomical gift, if medically acceptable, to take effect upon my death. The words and marks below indicate my wishes. ! give (a)_any needed tissues or organs (b)_only the following tissues or organs Specify the tissue(s) or organ(s) for purposes of transplantation, therapy, medical research or education; (c)_my body for anatomical study if needed. Limitations or special wishes, if any:_ cut here | - r UNIFORM DONOR CARD Print or Type Name of Donor In the hope that I may help others, I hereby make this anatomical gift, if medically acceptable, to take effect upon my death. The words and marks below indicate my wishes. I give (a)_any needed tissues or organs (b)_only the following tissues or organs CUT HERE UJ cc UJ X I- 3 o Specify the tissue(s) or organ(s) for purposes of transplantation, therapy, medical research or education; (c)_my body for anatomical study if needed. Limitations or special wishes, if any:_ Signed by the donor and the following two witnesses in the presence of each other: Signature of Donor Date of Birth of Donor Date Signed City and State Witness Witness (Preferably Next of Kin) This is a legal document under the Uniform Anatomical Gift Act of similar laws. Signed by the donor and the following two witnesses in the presence of each other: Signature of Donor Date of Birth of Donor Date Signed City and State Witness Witness (Preferably Next of Kin) This is a legal document under the Uniform Anatomical Gift Act of similar laws. Signed by the donor and the following two witnesses in the presence of each other: Signature of Donor Date of Birth of Donor Date Signed City and State Witness Witness (Preferably Next of Kin) This is a legal document under the Uniform Anatomical Gift Act of similar laws. Signed by the donor and the following two witnesses in the presence of each other: Signature of Donor Date of Birth of Donor Date Signed City and State Witness Witness (Preferably Next of Kin) This is a legal document under the Uniform Anatomical Gift Act of similar laws. j I Approved by Patient/Family Health Education Committee December, 1995 VETERANS AFFAIRS MEDICAL CENTER DENVER, COLORADO