doctors there are no legal routes in Oklahoma for who should be making decisions for you. Texas, surrounding states, and the federal laws say the spouse, adult children, parents and such should be making those decisions for you, but we do not have that system in place here in Oklahoma. While we follow that hier- archy, there is nothing that says we have to. I have seen a situation where the individual wanted a different person making medical de- cisions for him and that decision went to someone else. That’s why it is important to fi ll out the section of the advance directive per- taining to the healthcare proxy who makes medical decisions for you.
Q: What else does an advance di-
rective entail? The second part of the advanced directive deals with how patients want to be treated if a terminal illness develops and patients are thought to have 6 months or less to live. The other aspect would be when a patient devel- ops an end-stage disease such as Alzheimer, heart failure or renal failure in which treat- ments are not going to improve a condition, when death is imminent or the illness will result in a persistent unconscious state where no interaction is possible—a massive stroke for example.
Q: What does Oklahoma law say if there is nothing fi lled out on
paper? Oklahoma laws, by default, assume that re-
gardless of how ill patients may be or how likely it is that they will soon pass away from their illness they want everything done to keep them living including cardiopulmonary resuscitation (CPR) and intubation with me- chanical ventilation (artifi cial breathing). If patients do not wish to pursue those life-sus- taining measures since they will not prolong life in a meaningful way, those wishes need to be documented on paper; otherwise we must proceed as Oklahoma law mandates. I have witnessed such scenarios with the ultimate outcome being poor. That is why everyone should have these forms fi lled out if they are 18 or older.
Q: How should people go about
completing these forms? There are several options for completing these forms. Organizations such as the Oklahoma Bar Association, Oklahoma Medical Society, a doctor’s offi ce or local hos- pitals should have copies of advance directives for anyone who wishes to complete them. The
healthcare proxy and an alternate should be identified, and resuscitation preferences should be noted under the terminal illness section along with preferences for artifi cial nutrition and hydration. Those two sections comprise the healthcare proxy and living will. Once the form is signed, it needs to be wit- nessed by two different people. The Oklahoma form will also have a section on whether an individual would like to become an organ do- nor. Unlike the estate planning forms that give individuals durable power of attorney for healthcare, advance directives do not need to be notarized.
Q: What if someone has a change of heart about a previously fi lled
form? People are free to change the content of an advance directive form as frequently as they wish to do so. Only the most recent copy is valid as someone’s most recent wishes. It is very important that close family members are aware of changes in order to ensure there is no disagreement if the situation ever comes up. It is especially important to maintain your healthcare proxy and alternate aware of these changes as they will be the ones carrying out your wishes.
Q: When does the advance direc-
tive take effect? These forms only take effect when a patient is unable to make medical decisions. This includes patients who are in a per- sistently unconscious state or an illness that is either terminal or end-stage. Patients are ex- pected to make their own decisions if they are admitted for an acute illness such as a motor vehicle accident. Advance directives will not prohibit you from obtaining such emergent care. It would only be used if someone had a serious injury and ended up going into one of the categories listed above
Q: What is the difference be- tween advance directives and
DNR orders? A Do Not Resuscitate (DNR) order is a sep- arate document that people with very serious illnesses oftentimes complete if they feel that sudden death could happen from their illness. Those patients are usually very sick and have chosen to not undergo resuscitation under any circumstance.
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