Oklahoma Advance Directive Instructions

End-of-life decisions can create chaos for families already stressed with facing the death of a loved one. An update to the Oklahoma advance directive form was recently authorized by the state Legislature, making it easier to communicate to doctors and family members one’s wishes to decline or withdraw medical care when one is diagnosed with a terminal illness or is persistently unconscious.

"What is the Advance Directive?"

Oklahoma's Advance Directive for Health Care allows you, if you are 18 years of age or older, to inform physicians and others of your wishes to decline or withdraw life-sustaining medical care and to donate specified organs when you have been diagnosed by your attending physician and another physician to be in a terminal condition or persistently unconscious state. The Advance Directive also allows you to appoint a Health Care Proxy to make certain decisions on your behalf.

If you have completed an Advance Directive and been diagnosed as terminally ill or persistently unconscious by two physicians as defined in the Directive and your attending physician does not want to comply with your wishes, that physician must act promptly to arrange for your care by another physician or health care provider.

After you complete an Advance Directive, you may revoke it in whole or in part at any time and in any manner, without regard to your mental or physical condition. A revocation is effective upon your communication to your attending physician or other care provider or a witness to the revocation.

Make copies of your Advance Directive for your personal records, your family, your physician, your attorney, your Health Care Proxy and alternate Health Care Proxy. If your physician is unwilling to comply with the Advance Directive, the physician must tell you.

If you signed a Directive to Physicians, it is recommended that you complete the new Advance Directive because of additional options under the existing law.

What is an Advance Directive for Health Care
(Living Will)?

QUESTION: What is an Advance Directive for Health Care?

ANSWER: An Advance Directive for Health Care is a written legal document which follows to the language required by Oklahoma law. It may be signed by any person of sound mind and 18 years of age or older. Its purpose is to inform physicians and others of your wishes to decline or withdraw medical care when you have been diagnosed by an attending physician and another physician to have a terminal condition or illness or be persistently unconscious. The Advance Directive for Health Care may include a living will, the appointment of a health care proxy and directions for organ donation. (A proxy is a person authorized to act for another.)

QUESTION: Does the signing of an Advance Directive require witnesses and a notary public?

ANSWER: An Advance Directive is required by law to be signed before two witnesses over the age of 18 years of age who will not inherit from you either under your estate planning documents or under Oklahoma's heirship law if you have no Last Will and Testament. This is required to verify that the Directive has been willingly and voluntarily signed by a person of sound mind. The Advance Directive is not required to be signed before a notary public. It is recommended that underneath your final signature in the Advance Directive that you add your birth date and social security number.

QUESTION: What is the living will portion of an Advance Directive?

ANSWER: In the living will portion of your Advance Directive you may direct that life-sustaining treatment be withheld or withdrawn if such treatment would only serve to prolong dying if you have a terminal condition or are persistently unconscious. As part of this Living Will you may elect whether you desire the artificial administration of food and water under these circumstances. You may also give other specific medical directives regarding other treatments such as pain medication, dialysis, use of antibiotics and emergency resuscitation. One could even use the other medical directive section alone to direct that all possible treatment be given to preserve existence regardless of the prognosis or likelihood of success.

QUESTION: What is the health care proxy portion of an Advance Directive?

ANSWER: This section allows a person you appoint and an alternate to make decisions in consultation with your physician about life-sustaining treatments you are to receive if you are unable to make your own decisions and are determined to be terminally ill or persistently unconscious. In this section, you can also direct that your health care proxy be allowed to make decisions about artificial administration of food and water, dialysis, and other special medical treatments. It is important that you explain your desires to your health care proxy and alternate, and that these desires are expressed by your living will.

QUESTION: What does "terminal condition" mean?

ANSWER: A terminal condition is an incurable, irreversible condition that, even with the administration of life sustaining treatment, such as ventilators, breathing machines, pacemakers, heart beat stimulators, and drugs to stimulate heart and lungs, will, in the opinion of your attending physician and another physician, result in death within six (6) months.

QUESTION: What is "life sustaining treatment?"

ANSWER: Life sustaining treatment means any medical procedure or intervention, including administration of cardiac and pulmonary resuscitation (commonly called CPR), the artificial giving of food and water through intravenous solutions, nasal or surgically inserted feeding tubes, which could prolong the process of dying or maintain you in a condition of persistent unconsciousness. It does not include the giving of medication or medical treatment necessary to alleviate pain, nor does the term include the normal consumption of food and water by mouth.

QUESTION: What does the term "persistently unconscious" mean?

ANSWER: "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.

QUESTION: May I direct organ donation in my advance directive?

ANSWER: Section III entitled "Anatomical Gifts" gives you the opportunity to direct organ donations you may desire. Recent legislation clarifies that your family cannot preempt your decision for organ donation directed in your Advance Directive.

QUESTION: What happens if my attending physician does not want to comply with my wishes as expressed in my Advance Directive?

ANSWER: If you have completed an Advance Directive and have been diagnosed as terminal or persistently unconscious by two physicians as defined in the directive, and your attending physician or other health care provider does not want to comply with your wishes, that party is required by law to promptly so advise you, and as promptly as practical, to take all reasonable steps to arrange your care by another physician or health care provider. If your physician or health care provider refuses to comply with a medical treatment decision made by you in the Advance Directive or by you if you have decision making capacity, and if such refusal would in reasonable medical judgment likely result in your death, then your physician or health care provider must comply with your decision pending your transfer to a physician or health care provider willing to comply with your directions. Completing an Advanced Directive does not change your doctor's obligation to provide treatment for your pain or other comfort care.

QUESTION: Is the Advance Directive honored by my attending physician if I am pregnant?

ANSWER: No. If the attending physician is aware of the patient's pregnancy, the Advance Directive will not be operative during the course of the pregnancy. Also, in cases where a possibility of pregnancy exists (considering the patient's age and other factors), the physician may be required to determine whether or not a patient is pregnant.

QUESTION: Can I be required to complete an Advance Directive?

ANSWER: Although having an Advance Directive may be a good idea, it is illegal for anyone to require that you execute one 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.

QUESTION: Does a Directive to a Physician executed prior to September 1, 1992, under the Oklahoma Natural Death Act, remain in effect?

ANSWER: If you signed a Directive to Physicians under the Oklahoma Natural Death Act, which was the law in effect prior to September 1, 1992, it remains effective until revoked by you, and it has the same force and effect as if signed under the Oklahoma Rights of the Terminally Ill or Persistently Unconscious Act, which became effective on September 1, 1992. It is recommended, however, that you consider signing a new Advance Directive for Health Care because of additional options available to you under the current law.

QUESTION: Does the Advance Directive require my signature more than one time?

ANSWER: 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, you may wish to discuss them with your attorney.

QUESTION: How is the Advance Directive different from a Do-Not-Resuscitate (DNR) Consent?

ANSWER: The DNR Consent is legal directive that may be used by persons who, because of their condition, want to direct that CPR not be given under any circumstance, in event of heart or respiratory stoppage. This directive does not affect a health care provider's duty to provide other emergency care including the Heimlich maneuver.

QUESTION: If I sign an Advance Directive how am I protected from a misjudgment by a physician?

ANSWER: Oklahoma law requires a separate, and agreeing, determination of your affliction with a terminal condition or persistently unconscious by a second physician, put in writing and filed as part of your medical records at the facility where you are a patient.

QUESTION: Can I revoke a signed Advance Directive?

ANSWER: 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. You may revoke the Advance Directive by destroying it, by communicating that desire to the attending physician or other health care provider, by revoking the Advance Directive before a witness, or by having a witness to the revocation so inform your attending physician or other health care provider.

QUESTION: If I have signed more than one Advance Directive, which one will be effective?

ANSWER: 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 in effect.

QUESTION: Is a document executed in another state and similar to Oklahoma's Advance Directive for Health Care honored in Oklahoma?

ANSWER: If you signed a formal document in another state, which provides for the withholding or withdrawal of life-sustaining treatment or for the appointment of another to 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.

QUESTION: After signing an Advance Directive, to whom should I give copies of it?

ANSWER: 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.

How to Complete the Advance Directive

Print your name, preferably as it appears on your Social Security card, on the first line of the Advance Directive.

I. The Living Will

Initial in the "yes" or "no" box about whether you wish to have life-sustaining treatment withheld or withdrawn when you are in a terminal condition or are persistently unconscious, in Paragraph b(1)(a) and (b).

Initial in the "yes" or "no" box about whether you wish to have artificially administered hydration and nutrition withheld or withdrawn when you are in terminal condition or are persistently unconscious, in Paragraph b(2)(a) and (b).

If you have any other medical directives, list them in Paragraph b(3) and initial "yes" or "no."

II. Health Care Proxy

Print the name of your Health Care Proxy and Alternate Health Care Proxy in the spaces provided.

In order for your Health Care Proxy to make medical treatment decisions and decisions about having life-sustaining treatment in accordance with your wishes as indicated in your living will, please place your initials in the "yes" or "no" box.

III. Organ donation

If your desire to donate your entire body or designated body organs or body parts for purpose of transplantation, therapy, advancement of medical or dental science or research or education, you may do so by completing and initialing "yes" in this section.

IV. Other Provisions

Read the provisions in this section.

Date and sign the document in the space provided.

Be sure to list the city, county and state of residence. As an option, list your date of birth.

Have two people witness your Advance Directive. Remember, they must be 18 years or older and cannot be anyone who will inherit from you.

Definitions

Life Sustaining Treatment: Any medical procedure or intervention, including administration of cardiac and pulmonary resuscitation (commonly called CPR), the artificial giving of food and water through intravenous solutions, nasal or surgically inserted feeding tubes, which could prolong the process of dying or maintain you in a condition of persistent unconsciousness. It does not include the giving of medication or medical treatment necessary to alleviate pain, nor does the term include the normal consumption of food and water by mouth.

Artificially Administered Hydration and Nutrition: Feeding through intravenous solutions, nasal or surgically inserted feeding tubes.

Health Care Proxy: A person you appoint to make health care decisions for you when you cannot make them for yourself.

Organ Donation: a donation at the time of death of the entire body or designated body organs or body parts in accordance with the Uniform Anatomical Gift Act.

Persistently Unconscious: An irreversible condition, diagnosed by an attending physician and another physician, in which thought and awareness of self and environment are absent.

Qualified Patient: Anyone 18 years of and older who has completed an Advance Directive and has been diagnosed to be in a terminal condition or persistently unconscious by the attending physician and another physician.

Terminal Condition: An incurable and irreversible condition that even with the administration of life-saving treatment such as ventilators, breathing machines, pacemakers, heart beat stimulators, and drugs to stimulate heart and lungs, will, in the opinion of the attending physician and another physician, result in death within the next six months.

Congratulations! You have completed the Oklahoma Advance Directive for Health Care. Make sure a copy of the Advance Directive becomes a part of your medical record. Keep the Advance Directive with your personal records, and give other copies to your family, your attorney, and your Health Care Proxy and Alternate Health Care Proxy.