Advance Directives & End-of-Life Planning

An accident or serious illness can affect anyone at any age. Thinking about this in advance and creating an Advance Directive gives the person the chance to discuss options and concerns with your family and physician if an accident or illness prevents the person from making medical decisions in the future.

Not only do Advance Directives dictate what measures a person does not want, they also include the treatment options a person would like to receive. It is a chance for a person to express his or her personal values and wishes for health care decisions. Even if life-sustaining treatments are limited by your Advance Directive, you will still receive other treatments that will help you with pain control and comfort.

Life-sustaining treatment maintains life when an organ or body system ceases to function at a level adequate for survival. Life-sustaining technologies include antibiotics and other medications, IVs, and machines or medical procedures that can keep a person alive.

Regardless of any decision about medical treatment, including life-sustaining treatment, the person will continue to receive appropriate medical and nursing care necessary to ease pain and suffering.

Life can be sustained by liquid food and water given intravenously or by inserting a tube through the nose or stomach. This is called “medically assisted nutrition and hydration.” Under special circumstances, medically assisted nutrition and hydration may be determined to be a greater burden than benefit to the person and thus may be withheld or withdrawn. If food or water no longer gives comfort and a person is imminently dying, or the person’s body can no longer digest food, a Catholic health care institution would honor the person’s request to not start, or stop, artificial hydration and nutrition.

Every person admitted to an Avera facility will receive life-sustaining treatment, including CPR, unless a decision not to code (not to revive from apparent death) was previously made. A “No Code” or “DNR” order is made only after thoughtful discussion between the physician, a competent person and any others involved in the decision-making process.

If a decision is made that the person should not be revived from apparent death and the physician authorizes a “No Code” or “DNR” order, it does not mean that all medical and nursing care will be withheld. Supportive care will continue to be provided.

Most state laws require the individual to consider the recommendation of the attending physician, the decision that the person would have made if the person then had decisional capacity, if known, and the decision that would be in the best interest of the person. Decisions by the individual appointed must be in accordance with accepted medical practice and, at Avera facilities, with the Ethical and Religious Directives for Catholic Health Care Services (ERDs).

Likewise, in order to be followed at an Avera facility, your Advance Directive must be in accordance with accepted medical practice and the ERDs

Mechanical ventilation is a medical treatment that uses equipment or machines to breathe for patients who are unable to breathe on their own. This requires a tube to be inserted through the nose or the mouth into the trachea (windpipe). The patient will be unable to speak, eat or drink. If mechanical ventilation is necessary for more than two weeks, a tracheotomy often is required. A tracheotomy is an incision through the neck into the trachea through which a tube is inserted. The tube can be used for both mechanical ventilation and to suction fluids which might interfere with breathing.

A ventilator is a machine that mechanically controls or assists respirations (breathing) when patients are unable to breathe adequately on their own.

Brain death is the absence of all brain activity. When this occurs, the patient cannot recover and is considered legally dead, even though other vital organs may continue to function.

If your heart stopped beating (cardiac arrest), you would die within a very few minutes unless immediate action is taken. CPR was developed to help the heart begin to function again. It generally consists of chest compression, mechanical ventilation, medication and electrical shocks to the heart.

If you are unable to take liquid or food by mouth, or if you are unable to digest your food properly, you may receive fluids and/or nutrition by one or more of the following techniques:

Intravenous (IV): IV solutions are used to provide you with fluid, vitamins, salts, minerals and medication. A small tube is inserted into a vein in your arm or hand. The amount of calories that you can receive through this method is not enough to keep you alive for long periods of time.

Total parenteral nutrition (TPN): TPN is a special IV solution containing enough vitamins, salts, minerals and adequate calories to sustain life. This technique requires a special IV line, different from that described above, and is generally used in situations when you are unable to take food by mouth or digest it properly.

Tube Feeding: Liquid food can be given through a variety of tubes inserted into the stomach of a patient capable of digesting food. A nasogastric or feeding tube may be inserted through your nose into your stomach. If you need to be fed this way for a long time, a special tube may be surgically inserted into the stomach.

Do Not Resuscitate (DNR) is an order written and signed by the physician instructing staff not to begin CPR or another life-sustaining treatment if the person’s heart or respirations have stopped (cardiac or respiratory arrest). This order is usually written when someone is terminally ill or near death. Only a physician or advanced practice provider can authorize a No Code or Do Not Resuscitate order. Before a physician/advance practice provider authorizes such an order, he/she will discuss the situation and terminal condition with the patient and/or family.

Supportive care is providing for the comfort and dignity of the patient whatever decisions are made concerning life-sustaining treatments. Appropriate medical and nursing care will be continued to provide comfort, hygiene and dignity, whether or not life sustaining treatments are being administered. The use of medications, with the intention of easing pain, is permissible even if the medication may unintentionally hasten death.

Terminal illness is the end stage of a disease process, injury, or illness that is incurable, irreversible and will result in death within a foreseeable, but uncertain, time period.