Advance Directive - Oklahoma Bar Association

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Q: What is an Advance Directive for Health Care?
A: An Advance Directive for Health Care is a written legal
document which allows you to instruct your attending physician whether or not you wish to be given life-sustaining
treatments and artificially administered nutrition (food) and
hydration (water) and to give other medical directions that
impact the end of life. Its purpose is to recognize your right
to control some aspects of your medical care and treatment,
primarily the right to decline medical treatment or direct that
it be withdrawn even if death ensues. An Advance Directive
for Health Care may include a living will, the appointment
of a health care proxy (a proxy is a person authorized to act
for another) and directions for organ donation.
Q: Who can sign an Advance Directive for Health
Care?
A: Any person of sound mind who is 18 or older.
Q: Does the signing of an Advance Directive require
witnesses and a notary public?
A: An Advance Directive must be signed before two
witnesses who are 18 or older. The witnesses cannot be
beneficiaries under your will, nor may they be persons who
would inherit your property if you died without a will. An
Advance Directive is not required to be notarized.
Q: When does an Advance Directive go into effect?
A:
An Advance Directive goes into effect when your
attending physician and another physician determine that
you are no longer able to make decisions regarding your
medical treatment and you are in one of the three conditions explained on next page. Advance Directives do not
determine your medical treatment in situations that do not
affect your continued life, such as routine medical treatment
and non life-threatening medical conditions.
Q: What conditions does an Advance Directive cover?
A: An Advance Directive covers three conditions: 1)
terminal condition, 2) persistently unconscious and 3) endstage condition.
Q: What does “terminal condition” mean?
A: A terminal condition is an incurable, irreversible condition that, even with the administration of life-sustaining
treatment (such as putting a person on a respirator, dialysis,
pacemakers, surgery, blood transfusions and antibiotics)
will, in the opinion of your attending physician and another
physician, result in death within six months.
Q: What does the term “persistently unconscious”
mean?
A: “Persistently unconscious” means an irreversible condition as determined by your attending physician and another
physician, in which thought and awareness of self and
environment are absent.
Q: What is an “end-stage condition”?
A: An “end-stage condition” means a condition caused by
injury, disease or illness which results in severe and permanent deterioration indicated by incompetency and complete
physical dependency for which treatment of the irreversible
condition would be medically ineffective.
Q: What is the living will portion of an Advance Directive?
A: In the living will portion of your Advance Directive
(Section I) you may direct that your life not be extended by
life-sustaining treatment if you 1) are in a terminal condition, 2) are persistently unconscious or 3) have an end-stage
condition. Alternatively, you can direct that you are to be
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Oklahoma Bar Association
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given life-sustaining treatment if you are in any of those
three conditions.
not want to comply with my wishes as expressed in
my Advance Directive?
You also have the ability to direct whether or not you
wish to receive artificially administered nutrition (food)
and hydration (water) if you are unable to take food
and water by mouth in each of the three conditions
described. Artificially administered food and water
normally involves the surgical insertion of a feeding
tube into your stomach.
A: In that case, your attending physician is required, as
promptly as practicable, to take all reasonable steps to
arrange for your care by another physician.
Oklahoma law does provide that even if life-sustaining
treatment or artificially administered nutrition and hydration are withheld or withdrawn, you shall be provided
with medication or other medical treatment to alleviate
pain, and you will be provided with oral consumption
of food and water if you are able to eat or drink.
Q: What is the health care proxy portion of an Advance Directive?
A: A health care proxy is a person who is authorized
to make medical treatment decisions for you in the event
that you are unable to make such decisions. Section II
of Oklahoma’s Advance Directive allows you to appoint
a health care proxy (such as your spouse or adult child)
to make whatever medical treatment decisions you could
make if you were able. You can also appoint an alternate
(back-up) health care proxy to serve in the event your
health care proxy is unable or unwilling to serve. Your
physician is directed to follow the instructions of your
health care proxy. While your health care proxy can
make decisions regarding life-sustaining treatment and
artificially administered food and water, such decisions
must be in accord with your wishes on those subjects as
you specify in the living will portion of your Advance
Directive. Therefore it is important that you discuss
these subjects in advance with your health care proxy
and that you choose someone who supports your wishes
as set forth in your living will.
Q: May I direct organ donation in my Advance Directive?
A: Yes; Section III, titled “Anatomical Gifts,”
gives you the opportunity to direct the donation of your
entire body or designated body organs.
Q: What happens if my attending physician does
Q: Is the Advance Directive honored by my attending physician if I am pregnant?
A: Oklahoma law provides that a person who has been
diagnosed as pregnant and whose attending physician
is aware of the diagnosis will be provided with lifesustaining treatment and artificially administered hydration and nutrition unless the person has, in her own
words, specifically authorized that during a course of
pregnancy, life-sustaining treatment and/or artificially
administered hydration and/or nutrition shall be withheld or withdrawn.
Q: Can I be required to complete an Advance Directive?
A: No. It is illegal for anyone to require that you execute
an Advance Directive as a condition of receiving health
care services or health insurance coverage. It is also illegal
for anyone to modify your life insurance coverage, or to
refuse to issue life insurance coverage to you, because
you have executed an Advance Directive.
Q: Are Directives to a Physician or Advance Directives executed under prior laws still valid?
A: Yes. If you signed a Directive to Physicians under
the Oklahoma Natural Death Act, which was the law in
effect prior to Sept. 1, 1992, or an Advance Directive
for Health Care under the law in effect prior to May
2006, it remains valid until you revoke it. However, it is
recommended that you consider signing a new Advance
Directive for Health Care because of additional options
available to you under the current law.
Q: Does the Advance Directive require my signature
more than one time?
A: The Advance Directive requires that you initial
multiple times but requires your signature only once at
the end. Remember that this is a legal document, and if
questions arise concerning portions that seem unclear,
This information is provided by the
Oklahoma Bar Association
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you may wish to discuss them with your physician and/
or attorney.
Q: How is the Advance Directive different from a
Do-Not-Resuscitate (DNR) Consent?
A: A DNR consent form deals only with the subject
of cardiopulmonary resuscitation (CPR) in the event of
a cardiac or respiratory arrest. In such a document, a
person can state that the person does not consent to the
administration of CPR in the event the person’s heart
stops beating or the person stops breathing.
Q: If I sign an Advance Directive how am I protected
from a misjudgment by a physician?
A: Oklahoma law requires that both your attending
physician and another physician who has examined you
determine that you are incapable of making an informed
decision regarding your health care, including the provision, withholding or withdrawal of life-sustaining treatment. This determination has to become part of your
medical record.
Q: Can I revoke a signed Advance Directive?
A: Yes. An Advance Directive may be revoked by you,
either entirely or as to any part, at any time and in any
manner, regardless of your mental or physical condition. The revocation becomes effective when you (or
a person who witnessed the revocation) notify your attending physician or other health care provider of the
revocation.
Q: If I have signed more than one Advance Directive, which one will be effective?
A: In the event you signed more than one valid Advance
Directive, none of which have been revoked by you, the
most recently signed Advance Directive will be considered
your last wishes and the one given effect.
Q: Is a document executed in another state and similar to Oklahoma’s Advance Directive for Health Care
honored in Oklahoma?
which provides for the withholding or withdrawal of lifesustaining treatment or for the appointment of another to
provide, withhold or withdraw life-sustaining treatment,
and that document complied with the law of the state in
which signed, it is valid in Oklahoma to the extent it does
not exceed authorizations under Oklahoma law. However,
Oklahoma residents should sign an Advance Directive that
complies with the Oklahoma law if at all possible.
Q: After signing an Advance Directive, to whom should
I give copies?
A: You should consider making copies of your Advance
Directive for your personal records, your family, your physician, your attorney, your health care proxy and alternate
health care proxy. Have additional copies ready to take with
you when you require hospitalization or other care as your
health care providers will need a copy for your medical record. You should keep a list of persons to whom you have
given a copy of your Advance Directive so that if you later
change it or revoke it, you may collect the copies.
Q: Where can I acquire a copy of an Advance Directive?
A: A copy of an Advance Directive for Health Care may
be obtained from the Oklahoma Bar Association (www.
okbar.org/public/brochures), or your attorney.
(Revised October 2012)
All Rights Reserved
Copyright ©2012 Oklahoma Bar Association
Prepared and Issued by
Oklahoma Bar Association
1901 N. Lincoln Blvd.
P.O. Box 53036
Oklahoma City, OK 73152
www.okbar.org
405-416-7000
A: If you signed an Advance Directive in another state,
This information is provided by the
Oklahoma Bar Association
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