IMPORTANT CHOICES

There may come a time when you or a member of your family becomes seriously injured or critically ill. Grief and shock may dominate your emotions, affecting your ability to make important decisions. These decisions include whether to withdraw “life sustaining” treatment, who should make such decisions in the event that you are unable, and whether your organs should be donated in the event of your death.

This publication is designed to help you better understand these issues by providing you with information concerning:

1. Your rights and responsibilities as a patient;
2. Making bioethical decisions;
3. Organ donation;
4. Advance directives;
5. Mental health treatment; and
6. Legal documents regarding:

•   “Consent to Medical Treatment”

•   “Medical Power of Attorney”

•   “Directive to Physicians”

•   “Declaration for Mental Health Treatment” and

•   “Out of Hospital Do Not Resuscitate”

Should you or members of your family need additional assistance with any of these matters, please feel free to contact Social Services, D.M. Cogdell Memorial Hospital (325) 574-7277.

The health care professionals at D.M. Cogdell Memorial Hospital recognize that each patient is an individual with unique health care needs. We respect the dignity and worth of every person, and continually strive to provide considerate, respectful care focused upon the patient’s individual needs.

We believe a person’s health is affected by environmental and emotional factors, and that being able to communicate concerns with the health care team is important to the healing process as well as being a primary right of the patient. Our organization assists patients in the exercising of these rights.

Our patients have the right to exercise these rights without regard to sex, culture, economic status, educational, or religious background or the source of payment for care:

• Be provided information and assistance in understanding information throughout their stay and about their condition, rights and responsibilities.
• Have a written copy of the patient’s rights and responsibilities upon admission in the patient’s primary language, or have an appropriate translator.
• Receive a reasonable response to requests and needs for treatment of service.
• Impartial access to medically appropriate treatment that promotes continuity of care.
• Considerate and respectful care that recognizes psychosocial, spiritual, and cultural variables, preserving human dignity.
• Access to pastoral care and other spiritual services.
• Be free from all forms of abuse or harassment, including verbal, physical, psychological, sexual or emotional while under the care of the hospital.
• Access to protective services.
• Be free from restraints of any form that are not medically necessary or are used as a means of coercion, discipline, convenience, or retaliation by staff.
• The opportunity to voice complaints about his or her care, and to have those complaints reviewed and, when possible, resolved. Patients and/or family members who have a complaint are encouraged to call Risk Management (325) 574-7282, Patient Care Supervisor (325) 574-7290, Nurse Executive (325) 574-7239, or CEO (325) 574-7436 at D.M. Cogdell Memorial Hospital. If a patient or family member wishes to lodge a formal complaint with the Texas Department of Health, they may do so either by phone, fax or mail to:

Health Facility Compliance Division

Texas Department of Health

1100 W 49^th Street

Austin, TX 78756

FAX (512) 834-6653

• Personal privacy and confidentiality including:

o    Being interviewed, examined, and treated in surroundings designed to give reasonable visual and auditory privacy. Giving consent to any photographic technique that would allow or be used in such a way that personal identification is possible.

o    The medical record access restricted to only individuals directly in the patient’s care, or monitoring the quality of care, or authorized by law/regulation, or authorized by permission of the patient or legal representative.

o    Having access to the information in the patient’s hospital record by the patient or designated representative.

• Care of the dying which provides comfort and dignity to the patient through effective pain management, and acknowledgment of the psychological and spiritual concerns of the patient and the family regarding dying and the expression of grief.
• Express their spiritual beliefs and cultural practices as long as these do not harm others or interfere with treatment.
• Make health care choices together with the physician with respect to the following:

o    The acceptance of care and/or refusal of treatment and to be informed of the medical consequences of such refusal.

o    Formulation of advance directives and appointing a representative to make health care decisions on their behalf.

o    The involvement of family and/or guardian in the care choices throughout the course of treatment or the exclusion of any or all family members from participating in his or her care decisions.

• Be informed of any research/educational projects involving their care or treatment and to understand that refusal to participate in a research project will not affect their treatment or care.
• Have their guardian, next of kin or legal representative to exercise their rights if the patient is deemed legally incompetent, medically incapable of understanding the proposed treatment or procedure, unable to communicate health care choices, or is a minor.
• Have a family member or representative of the patient’s choice and his/her physician notified promptly of his/her admission to the hospital.
• Know the professional status of persons providing care and services, and any professional relationships of persons providing care.
• Reasonable personal and environmental safety.
• Request another health care practitioner or consultant from another facility.
• Transfer to another facility or organization if the patient is medically stable, has been completely examined by a physician, the need for transfer established and communicated to the patient and an accepting physician and facility secured.
• Request and receive a detailed explanation of a bill for services rendered.
• Ethical Issues: The Ethics Ad Hoc Committee of D.M. Cogdell Memorial Hospital serves as the advisory body to deal with ethical issues that arise in the case of treatment choice. The patient or designated representative can bring ethical issues to the committee by contacting Patient Care Supervisor (325) 574-7290 or Risk Management (325) 574-7282 at D.M. Cogdell Memorial Hospital.

Our patients have the responsibility to:

• Provide accurate and complete information relating to their health and medical care.
• Ask questions if they don’t understand their plan or care or expectations, and to make decisions regarding their medical care.
• Follow the recommended treatment plan and be responsible for actions and outcomes from refusing services/instructions.
• Assure prompt payment for financial obligations for services rendered.
• Follow hospital policies, procedures, rules and regulations as these affect patients, their families and visitors.
• Respect individuals and property of other patients, health care workers, visitors and the hospital.
• It is the responsibility of the patient who wishes to make an advance decision regarding his/her medical or surgical treatment, including the withholding or withdrawal of life sustaining procedures if he/she should become unconscious, incompetent or otherwise incapable of personally making a decision, to clearly indicate his/her desires to D.M. Cogdell Memorial Hospital and his/her attending physician.

Making Bioethical Decisions

“Bioethical” dilemmas involve values that touch upon the very deepest issues of human life:

• What is life?
• What is the ultimate good?
• What is my moral or ethical duty in this situation?
• How should I decide?

An Ethics Ad Hoc Committee exists in this hospital to help patients, physicians and the hospital staff through these decisions. It consists of a cross section of caregivers. The committee does not make the decision. The ultimate decisions are between the physician and family.

The Ethics Ad Hoc Committee provides consultation, promotes education related to values and choices in health care and engages in continuing self-education and dialogue. If you believe that you are dealing with an ethical dilemma related to health care and would like to contact the Ethics Ad Hoc Committee for consultation, contact Patient Care Supervisor (325) 574-7290 or Risk Management (325) 574-7282 at D.M. Cogdell Memorial Hospital.

Organ Donation

Each of us has the ability to “give the gift of life” by becoming an organ/tissue donor. At any given time more than 26,000 people in the United States are awaiting a transplant, yet thousands of healthy organs and tissues are wasted each year that could have been used either to save lives or make them better.

You can be a part of this life-saving effort by discussing organ donation now with your family and friends, thereby assuming the responsibility for that decision so that they will not have to.

A brochure explaining more about organ/tissue donation is available free of charge. The brochure includes a Uniform Donor Card, which is a legal document under state law through which you can express your desire to donate organs and/or tissue for transplant in the event of your death. A copy of the brochure can be obtained by contacting Patient Care Supervisor (325) 574-7290 or the Emergency Department at (325) 574-7230.

This information will explain your right to participate in health care decisions and how you can plan what should by done when you cannot speak for yourself. Modern health care works wonders. It is giving people a chance to live longer, fuller lives. Sometimes, however, medical advances seem to hold people captive or prolong their dying. Many in our society now question the use of medical interventions and technology when they prevent a terminally ill patient from dying “naturally”. They say it is futile to use technology that prolongs a patient’s agony and dying when he or she will never again be aware of life. Some say to prolong dying unnecessarily burdens the patient and family.

Planning ahead is important in selecting your medical treatment or the use of artificial life support. You should consider making advance directives for your health care. Think about the following situations:

• What treatment would you choose or refuse if you become temporarily or permanently unable to make or communicate decisions about your medical care, and a family member or friend must make decisions for you?
• What choices would you make if you were terminally ill and your death was imminent?
• What would you choose if you had no possibility of recovery from an unconscious state or were permanently dependent on artificial life support?

In planning for those situations, you should choose a family member or a friend who is familiar with your beliefs and values. You would rely on this person – your “surrogate” – to make the choice you would have made if you had not become incapacitated. It is important that you discuss your wishes with your surrogate so that he or she can act in your best interest.

Here are eight questions and answers that will help you plan. Some questions touch on sensitive ethical and religious topics. Answers to some of the questions may involve an understanding of your state law. Some raise further questions for which there are no clear-cut answers. Talking with your family, your physician, a priest, minister, rabbi, or other counselors whose views you respect may help you decide on the path best suited for you.

            A:   Accidents happen to people of all ages. You could suddenly become incapacitated by an accident or illness, or by a condition that could gradually (or sometimes quickly) lead to your loss of decision-making capabilities.

Q:   Do I have a right to direct my care?

            A:   Whether you are conscious and able to communicate, or unconscious and unable to communicate, you have two basic rights regarding medical treatment. First, you have the right to have the situation clearly explained to you or your surrogate. Second, you have the right to decide what health care you will receive, or will refuse.

This does not mean a doctor or a hospital must follow your instruction if they believe it is seriously wrong. They may notify you that they are unwilling to abide by your instruction. If you insist, it is the physician’s responsibility to find doctors and a hospital that will agree to follow your instruction.

Q:   What information do I need to make good health care decisions?

      A:   In order to make a reasonable decision, you have a right to the following kinds of information:

•     Your doctor’s diagnosis and prognosis of your medical condition.

•     What tests might determine the causes, or possible causes of your condition.

•     What treatment alternatives are available, including experimental or risky treatments that might be helpful?

•     What risks and benefits are involved in the different treatments?

•     What are the consequences of not having treatment?

•     What does your doctor recommend?

•     What are the expected costs and other burdens of proposed tests and treatment?

Q:   What does “Declaration for Mental Health Treatment” mean?

      A:   A signed Declaration for Mental Health Treatment indicates the kinds of mental health services you do or do not consent to (including such options as psychoactive medication, convulsive treatment and preferences for emergency treatment such as restraint, seclusion or medication). For the mental health directive to become effective, a judge must find that you lack the ability to understand the nature and consequences of a proposed treatment, including the benefits, risks and alternatives to the proposed treatment as well as the ability to make health care treatment decisions because of impairment and that you are incapacitated.

Q:   Why should I be concerned about making a Declaration for Mental Health Treatment?

      A:   This document allows you to tell the hospital providing mental health services what kinds of mental health treatment you want in the event you become incapacitated.

Q:   How can I influence my care if I am unable to decide for myself or I am unable to communicate?

      A:   It is important that you communicate clearly, in advance, what you would want if you should become unable to make or communicate decisions. In such situation, your reasonable directives should be followed if they are known.

In an emergency (and unless they know you would refuse care), health care professionals will do what they believe is necessary to save your life or prevent serious injury if you are unconscious. For adults, health care professionals will in many circumstances accept the reasonable directions of a spouse, an adult child or a surrogate. When the family disagrees, either someone in the family or the health care provider may ask a court to appoint a legal guardian to make decisions for you. For children, parents or a guardian usually make decisions about treatment.

Q:   How can I communicate my wishes regarding health care?

      A:   There are two major instruments that can be executed under Texas law in order to have a person’s desires regarding medical treatment known, in the event that the person is later unable to make such decisions.

The first is the Directive to Physicians under the Texas Natural Death Act. This is also known as the “living will”. It allows a person to tell physicians to withhold or withdraw life-sustaining procedures in the event of a terminal condition. It also allows a person to designate another individual to make treatment decisions if the person becomes comatose or incompetent (mentally or physically incapable of communication).

The second instrument is the Medical Power of Attorney. This special power of attorney allows a person to appoint an individual, and as many alternates as desired, who will be authorized to make any health care decision on behalf of the person granting the power of attorney (called the Principal), if the person (i.e. Principal) later lacks the capacity to make health care decisions for himself or herself. This allows a person to select, in advance, those persons he or she would want to make health care decisions in the event her or she later becomes incompetent.

Q:   How can I communicate my refusal of certain life-sustaining treatments in an out-of-hospital setting or location when health care professionals are called for assistance?

A:   The Out of Hospital Do-Not-Resuscitate (DNR) Order allows a competent adult to refuse certain life-sustaining treatments in locations such as long-term care facilities, inpatient hospice facilities, private homes, hospital outpatient areas and emergency departments, physicians’ offices, and vehicles during transport. When health care professionals respond and discover the Texas Department of Health’s standard identification device for this order, they will not provide the following:

•  Cardiopulmonary resuscitation (CPR)

•  Advanced airway management

•  Artificial ventilation

•  Defibrillation

•  Transcutaneous pacing

The health care provider will provide comfort care and other emergency care.

This publication cannot answer all the difficult questions that you might have about making medical choices for you in the event you cannot do so yourself. You should discuss these matters with your family, physician, priest, rabbi or other counselor.