In January, 2007 Act 169 was put into place. This Act is designed to provide new guidelines and help to clarify certain issues. An advance directive is a document that provides direction to healthcare providers/family about what the patient’s wishes are when he/she is no longer able to express such wishes. There are different types of advance health care directives. These include: a living will, a health care power of attorney, or a combination document that incorporates features of both. 

In addition to recognizing the living will, the Act recognizes a health care power of attorney and health care representative as decisions makers for patients. The Act provides explicit statutory authority, which can help caregivers and families when trying to address and adhere to patient healthcare wishes. Adults who have the capacity to make healthcare decisions can make an advance directive. The document does not need to be prepared by an attorney. Sample documents can be obtained from Social Work Department or off the internet, i.e., The Pennsylvania Medical Society (www.pamedsoc.org). The document must be dated and signed by the patient (if patient is unable to sign then the document must be signed/dated by an individual acting at the patient’s direction) and witnessed by two individuals who are at least 18 years of age. The witnesses cannot be healthcare providers or their agents, i.e., office staff. A copy of the document should be provided to the patient’s physician and to the hospital upon each and every admission. Note, patients are asked upon admission if they have an advance directive and encouraged to produce it for the medical record. Those patients without an advance directive are asked if they would like more information or would like to prepare an advance directive. This tool will help to guide treatment and/or provide direction as to decision maker.  

The documents are not operational until certain criteria are met. Living wills are honored only after the patient has been deemed incompetent and when he/she is determined by the physician to be permanently unconscious or in an end-stage condition. If the patient has not met these criteria then the physician/healthcare provider must look to the healthcare power of attorney or healthcare agent in absence of a legal guardian to direct the health care of a given patient’s life.  

Unless a patient designated otherwise, the patient’s healthcare representative will be determined by a statutory list that generally gives priority in the following order: 

1. Spouse and adult child who is not the child of the spouse
2. Adult child
3. Parent
4. Adult sibling
5. Adult grandchild
6. Close friend

Working with patient and families can be very sensitive and difficult when there is conflict or uncertainty as to the patient’s wishes. The need to approach patients and understand their wishes (and have the wishes documented) in advance to a healthcare crisis is critical to ensuring patient’s rights are met and continuum of care is provided.

April 16 is Healthcare Decision Day. This day is being sponsored by all the local hospitals and healthcare facilities in Pennsylvania and coordinated through HAP. We encourage you to offer information, have a frank discussion, and help patient’s prepare an advance directive. 

For questions or to request an educational program, please contact:

Joan Meighan, Director, Risk Management, DCMH & Taylor Hospital

Nancy Young, Director, Risk Management, CCMC, Springfield Hospital and Community Hospital