In the event that you are unable to make healthcare decisions for yourself, it is recommended that you have Advance Directives in place. These serve as legal documents that provide instructions about your healthcare preferences. If you ARE ABLE to make your own healthcare decisions, these documents would NOT be used, but they are good to have in place to help loved ones know your preferences in how you are cared for when you are unable to communicate your choices. Be sure to discuss advance care planning preparations through these directives so that proper instructions are in place in the event that a health emergency leaves you unable to represent yourself (i.e., stroke, coma, illness etc.)

  • WRH Advance Directive Packet - Download 
    NOTE: The packet requires two unrelated witness signatures (i.e. neighbor, friend, colleague), OR needs to be notarized.
    • Please fill out your advance directives paperwork and submit a copy to Western Reserve Hospital to include with your chart. 
      Patient Access
      Fax: (330) 971-7072
      In-person: Entrance 5, Booth 5 - Hours: Monday-Friday, 8 a.m. – 5 p.m.

Two types of Advance Directives for the state of Ohio:

Health Care Durable Power of Attorney: With this Advance Directive, you designate a person, either permanently or temporarily, to make healthcare decisions and speak on your behalf - for example, if you are under in a coma, under anesthesia or sedated.

A Living Will: With this Advance Directive, you set up detailed, written instructions regarding end-of-life preferences for healthcare - this directive would be activated if one is terminally ill and unable to make decisions, or if in an unconscious state.

Advance Directive Code Status
An informed decision about do not resuscitate status is an important part of your advance directives. Other than full code status, Ohio recognizes two DNR orders: DNR-CCA (Comfort Care Arrest) and DNR-CC (Comfort Care). Only a physician or Licensed Independent Practitioner can write a DNR order.

FULL Code - In case of cardiac arrest, healthcare personnel will attempt CPR and more generally will provide all medically indicated life-sustaining interventions, even if these serve primarily to prolong the process of dying. In the absence of a valid DNR order and DNR identification, a person is Full Code by default.
 
DNR/CCA - This order does not become effective until you experience cardiac or respiratory arrest. Up until the time you experience a cardiac or respiratory arrest, you will receive all medical care necessary to treat any illness or injury, including intubation. You will be treated as any other medical patient. Should you experience cardiac or respiratory arrest during treatment, at that time the DNR protocol will be initiated, and all resuscitative measures will stop
 
DNR/CCO - This order means that as soon as the form is signed, you will not receive any of the treatments listed in the DNR protocol as ‘Will Not,’ including resuscitative medications, CPR, ventilator care, continuous cardiac monitoring, or defibrillation.

RESOURCES:

FREQUENTLY ASKED QUESTIONS (FAQs)

What does having Advance Directives cost?
No charge - documentation services for Advance Directives are free

Are Advance Directives required?
Advance Directive documentation is NOT required but strongly advised. You can also choose to complete only one directive document and add other documentation later. It is recommended that adults have Advance Directives in place via their Electronic Medical Record (EMR). Though it is not an easy discussion to have, it is also best to have conversations with family members about your care wishes and brief them on specifics within your directive documents. When setting up directives, you must understand your options and communicate them in front of a witness or a notary.

Can I choose my care preferences based on my values and beliefs?
Yes - your personal choices based on your values and beliefs are always taken into account when your Advance Directives are set up. 

What if I want to change my Advance Directives?
You can amend your directives at any time by completing new paperwork. Changes should be written and submitted with a signature and date per state law. New copies should also be given to those who had former documents. (The latest version of your form/s on file is what will be followed. It is recommended that you:

  • Review and revise documents at least every 5 years
  • Consider Advance Directive changes when significant life events occur (i.e., a death in the family, a divorce, when children turn 18 years old, at the time of new health conditions or terminal illness diagnosis)

What to know about Advance Directives:

  • Any person over 18 years of age who can make their own decisions can set up Advance Directives. You do not need a lawyer to do this, however, the paperwork will need to be signed by two witnesses or a notary. 
  • Advance Directives fall to a next of kin/family member
  • Advance Directives are especially important if:

    • Your caregiver or healthcare representative is not a legal next of kin

    • You have multiple next of kin; OR

    • You have specific medical wishes related to a religious affiliation, family situation or medical condition

What happens if I do not have Advance Directives?
If you are unable to make healthcare decisions for yourself and do not have a Power of Attorney document in place, an Order of Decision Makers is initiated. A legal guardian named by the state becomes the first decision maker. Otherwise, the Order of Decision Makers for Ohio are:

  • Spouse
  • Adult children (majority of)
  • Parents
  • Adult siblings (majority of)
  • Or other nearest relative

Should someone in their 20s or 30s have a Living Will, or is it only for elderly citizens?
Whether you are 25 or 85, a Living Will is recommended documentation for the purpose of fulfilling your care wishes during any phase of life

Are standard forms for a Living Will and Durable Power of Attorney required, or can I create my own documents for my healthcare?
These types of documentation are to be done via state forms that have specified details per the Ohio Revised Code. 

Is a Durable Power of Attorney needed if I already have a Living Will pertaining to my healthcare?
Both documents are often recommended in order to speak to various aspects of your healthcare. A Living Will provides physician instructions when you are terminally ill or unable to recover consciousness to communicate your care preferences. A Durable Power of Attorney will address a broad scope of decisions that don’t require the patient to be terminally ill or unconscious, such as granting surgery approvals or changing doctors. Both documents, together, can assist you and your loved ones when handling your care to make sure your wishes are met.

Will I still get medication for my pain even if my Living Will does not stipulate life-saving orders when terminal or unable to communicate?
Yes - You would always receive care to provide as much comfort as possible.

Could I have a Durable Power of Attorney for mental health and medical reasons?
Yes - Whether for mental health or medical reasons, this documentation can speak to separate matters ntal health. Make sure the Durable Power of Attorney fully understands their part in knowing this in the decision-making process.

Can I change my mind about my Living Will preferences?
Yes, but you must notify all parties of the changes and supply new legal documentation with the amended wishes. Old documentation is then destroyed.

Is my care dependent upon if I am an organ donor or not?
No - Organ donor preferences play no part in the level of care you receive. Donor preferences are not evaluated until after death and Ohio Donor Registry details are only reviewed by authorized organ, tissue and eye recovery agencies.

Do I make a Do-Not-Resuscitate (DNR) order?
No - A physician is the only person who can set a DNR per their medical justification. Your physician will discuss this with you should you be terminally ill.

How is the decision made that someone is dying or is permanently unconscious without possible recovery?
Two physicians must determine this and must agree that sustaining life or recovery is no longer possible.

If a loved one is in a nursing facility and I am appointed proxy of the Durable Power of Attorney for their healthcare, can I act on their behalf in every aspect of their care?
Yes, but only if the loved one is unable to communicate their wishes.

Additional Information:
Ohio Legal Rights Service – 800.282.9181
Ohio Hospice and Palliative Care Organization – (614) 763.0050
Ohio Hospital Association – (614) 221.7614
Ohio Bar Association: Light the Way
Lifeline of Ohio – 800.525.5667
Ohio Department of Mental Health and Addiction Services – (614) 466.0236