We strive for our patients at St. Luke's Des Peres Hospital to be well-informed and prepared for any decisions that must be made during treatment. As our patient, you may face a difficult decision yourself. To prepare you for these moments, we encourage you to ask the following questions during the course of your treatment (if applicable):

• Why is this procedure or treatment necessary?
• What are my alternative options?
• What results, whether short term or long term, should I expect?
• Are there risks and, if so, what are they?
• What happens if I deny getting treatment?

Some patients may want to consider asking a lawyer to prepare a few documents in advance that will help with future healthcare decisions. We value the rights of our patients and want to keep you informed of what is available to you.

These legal documents act as a living will that provides instructions regarding who should oversee your medical treatment. In the event that you're unable to speak for yourself, they outline your end-of-life wishes.

You're not required to prepare these documents, but if questions arise about the kind of medical treatment you want or do not want, advance directives may help solve important issues.

Advance directives include a:

• Living will - A document that describes the kind of life-sustaining care you want if you become terminally ill and are unable to make your own decisions. A living will does not serve as "Do Not Resuscitate" orders or necessarily prevent lifesaving efforts from occurring. Through a living will, you can direct the withholding or withdrawal of any procedure or treatment that would only serve to prolong the dying process.
• Even with a living will, the law still allows your doctor to continue providing treatment to assure your comfort. This treatment could include giving pain medication and performing other procedures to make you more comfortable, even though all other life-support measures may have been withdrawn.
• Healthcare power of attorney - This document allows you to designate another person to make healthcare decisions for you if you're unable to communicate your wishes. There are no restrictions on the number of instructions you can give to your designee in this document.
• Mental healthcare power of attorney - This document allows you to designate another adult to make mental healthcare decisions if you're "incapable." To be considered incapable, a licensed psychologist or psychiatrist must certify that you're unable to give informed consent. A mental healthcare power of attorney must be in writing, agreed to by you while he/she is able to give informed consent and notarized or witnessed. The person given power of attorney can only make decisions consistent with the patient's wishes specified in writing. A patient can revoke his or her mental healthcare power of attorney - even if he or she is considered "incapable" - unless there is an express provision in the document to the contrary.

Forms for the living will and the healthcare power of attorney will be made available to you during your registration process at your request. You can also request them from your (or the patient's) nurse.

If you have any questions, or need assistance filling out these forms, please inform your nurse. If you have an existing advance directive, living will or healthcare power of attorney, please provide the hospital with a copy as soon as possible or consider completing new ones. This ensures that we understand and follow your wishes. You have the right to revise your advanced directive at any time.

Spiritual care services and/or case management staff are available to provide emotional support and guidance in medical decision-making, as well as explanations about resuscitation status, living wills and healthcare powers of attorney. Please inform your nurse that you would like to talk with someone regarding medical decision-making and/or advanced directives so that she/he can make the appropriate referral.

At any time, you can cancel or change any of these documents. To cancel your directive, destroy the original document and tell your family, friends, doctor or anyone else who has a copy that you have cancelled or changed it. To change your advance directives, simply write and date a new one and give copies to all appropriate parties, including your doctor.

DNR comfort care directives are another set of advance directive documents. They indicate that you don't wish to have cardiopulmonary resuscitation (CPR) attempted in the event your heart or breathing stops. These documents detail for healthcare workers that they may not:

• Start an IV (intravenous line)
• Provide respiratory assistance
• Insert a breathing tube or artificial airway
• Initiate cardiac monitoring
• Use alternative means of intervention

Patients may consider the following options should surgery be needed and are curious as to how the DNR Comfort Care status may affect healthcare decisions during operations:

• Discontinue advance directives during surgery.
• Continue advance directives but modify during surgery.
• Request no changes made to DNR comfort care orders.

This document designates whether you want emergency treatment by paramedics prior to admission or in the emergency department of your hospital. You can refuse CPR, assisted ventilation, emergency drugs, intubation or defibrillation. Your primary care doctor can assist you in obtaining this advanced directive.

This form enables us to bill your insurance company directly. You're responsible for any deductible and costs not covered by your insurance. Signing this agreement gives your consent for general nursing care, diagnostic testing and administration of medications as ordered by your doctor.