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Advance Healthcare Directive Questionaire
Who do you want to appoint to make your health care decisions if you are unable to?
*This person is called your Health Care Surrogate
Who can act as my health care surrogate? Anyone over the age of majority and of sound mind can act as your health care surrogate. Spouses and close family members are common choices. Who can create an advance healthcare directive / living will? Anyone over 18 years old with a sound mind can create an Advance Directive / Living Will.
If you would you like to appoint an Alternate Health Care Surrogate in the event that your primary health care surrogate is unavailable, enter their information below
What is a terminal condition? A terminal condition is an incurable injury or illness that will likely result in death within the near future. Additional medical treatment will only serve to postpone the moment of death. What is life support? Artificial life support is any life-prolonging procedure that helps to restore, replace, or maintain a spontaneous and vital bodily function. For example, assistance with maintaining breathing or blood pressure. Life support does not include medical treatment performed in a pre-hospital situation or artificially administered food/water or pain relief. What is comfort care? Comfort care is treatment with the sole objective of relieving pain. It may lengthen or shorten a person's life and does not include artificially administered food and water.
What is an end stage condition? An end stage condition is an irreversible condition, which has resulted in progressively severe and permanent deterioration, so that the patient cannot care for themself or make decisions for themself and the patient is expected to die without life-sustaining treatment. What is life support? Artificial life support is any life-prolonging procedure that helps to restore, replace, or maintain a spontaneous and vital bodily function. For example, assistance with maintaining breathing or blood pressure. Life support does not include medical treatment performed in a pre-hospital situation or artificially administered food/water or pain relief. What is comfort care? Comfort care is treatment with the sole objective of relieving pain. It may lengthen or shorten a person's life and does not include artificially administered food and water.
What is a persistent vegetative state? A vegetative state is a permanent and irreversible condition in which a person's autonomic functions, such as breathing and heart rate, continue but they make no voluntary actions or display any indication that they are aware of their own existence. What is life support? Artificial life support is any life-prolonging procedure that helps to restore, replace, or maintain a spontaneous and vital bodily function. For example, assistance with maintaining breathing or blood pressure. Life support does not include medical treatment performed in a pre-hospital situation or artificially administered food/water or pain relief. What is comfort care? Comfort care is treatment with the sole objective of relieving pain. It may lengthen or shorten a person's life and does not include artificially administered food and water.
How should I write my instructions? Each instruction starts with the phrase "I direct that". Write clearly and in full sentences to avoid ambiguity. Do not abbreviate words. Try to limit one instruction to each paragraph.