ALTERNATIVE DIRECTIVES: HOSPTIALS HOST TALKS ON CHANGE IN LAW

Beginning this month, every patient who is admitted to a hospital, skilled care facility or hospice program must be informed about state laws concerning the right to make decisions about his own medical care.

This includes the right to formulate advance directives, living wills and durable power of attorney for health care, which are documents that allow individuals to give directions about their future medical care.

A special program to explain advance directives what they are, how to prepare them and where to obtain the appropriate forms will be jointly sponsored by St. Francis Medical Center and Southeast Missouri Hospital Tuesday at the Drury Lodge.

The program will be presented twice by representatives of the Cape Girardeau law firm of Finch, Bradshaw, Strom and Steele. Stephen E. Strom will present the first session from 2-3 p.m. The program will be repeated from 7-8 p.m. by John P. Bradshaw. No reservations are needed and admission is free.

The change in hospital admitting procedures that requires institutions to give information and inquire about advance directives stems from a new federal law, the Patient Self-Determination Act, said the Rev. Ray Otto, director of Pastoral Care at Southeast Missouri Hospital.

The law, part of the 1990 Omnibus Budget Reconciliation Act, applies to all institutions that receive Medicare or Medicaid funds. It mandates that these institutions provide patients with written information about their rights to make decisions concerning their health care. Patients are not required to have advance directives.

The ground work for the Patient Self-Determination Act was laid in a recent U.S. Supreme Court decision regarding Nancy Cruzan, which indicated that all people have a constitutional right to refuse medical treatment, including life-prolonging procedures.

The court's decision also affirmed the right to name an agent to be a surrogate decision-maker for health care issues in the event an individual loses his decision-making capacity.

"Advance directives are documents that are written before an incapacitating illness occurs," Otto said. "In a directive, individuals can state their choices about medical treatments they wish to receive or decline, or they can name someone to make medical decisions for them if they are unable to communicate their wishes."

The most common kinds of advance directives are Living Wills and Durable Power of Attorney for Health Care, said Arthur F. Kelley, Pastor Care director at St. Francis Medical Center.

"Both provide individuals with the opportunity to make their wishes known," Kelley said. "However, a Living Will is more generalized than Durable Power of Attorney for Health Care."

Living Wills, which are now legal in 46 states, are written instructions that deal only with the kind of life-prolonging care an individual would want if terminally ill and unable to make medical decisions. The Durable Power of Attorney for Health Care allows an individual to appoint someone to speak on his behalf if he no longer can make health care decisions for himself.

"The Durable Power of Attorney is a broader document in that this form of advance directive can relate to any medical situation, not just terminal illness, and can include instructions about treatment preferrer or to be avoided, such as artificial nutrition and hydration," Kelley said.

"Advance directives are not designed to take decisions away from patients," Otto said. "What they are designed to do is encourage patients to consider their own spiritual and personal values and views as they relate to health care decisions."

Kelley added, "Advance directives are communication tools. They are a way for patients to let us know what their wishes are. And of course, as long as patients can make their own decisions whether or not they have executed advance directives it is both their right and responsibility to do so."