To some, it may be a piece of paper, but to the Rev. Cliff Nelson, it is a gift of love.
A health care directive, also known as a "living will," is "a gift of love that we give to our family or loved ones to help them in fulfilling the decisions we'd like to have done," explained Nelson, the director of Trinity Health's pastoral care department, which offers these directives to patients at Trinity.
The directive allows an appointed agent most likely a family member or a friend to serve as a power of attorney of sorts for all things related to health care.
There are three parts to the directive, with the first being that a patient appoints "an agent to make decisions for you if you're not able to make decisions on your own," Nelson said. "It would be basically in the event your condition is terminal. This does not go into effect until a person is in a terminal condition," like a comatose state.
Even if a patient is lucid and able to make decisions on their own, the directive can also include a clause where an agent can still make a decision. Nelson explained that there are times when an elderly parent states that while they can make their own decisions, "I just don't trust myself. I'd rather have my child or certain loved one do that for me because they would make the best decision for me."
The second part of the directive is to determine what should be done "in the event you are not able to make that decision on your own." Those decisions include whether or not a patient should be kept on life support, as well as if the patient should be resuscitated if needed.
"That would be the heart of it," Nelson said. "It's basically a do not resuscitate (order)."
The directive also offers guidance when it comes to hydration and/or nutrition when death is imminent. Nelson cited the case of Terri Schiavo, a woman who had been kept alive via feeding tube ever since she entered a vegetative state, following a heart attack, in 1990. Schiavo did not have a living will and a highly-publicized legal battle between her husband and her parents lasted for seven years until her feeding tube was removed; she died thirteen days later.
With the directive, Nelson said, it can prevent a patient from being kept alive with artificial means if he or she wishes to "let the disease do what its going to do, and let me die a natural death."
In the event that a person does not have a living will, there is a chain of command determined by North Dakota state law that hospitals follow if a patient's case needs a directive. The order that is generally followed starts with the appointed agent made through a health care directive; if there is none, the decision goes to a court appointed guardian or custodian. The law states that if there is a lack of a guardian or custodian, the following order is referred to: the patient's spouse, then the child or children of the patient; the parents; adult brothers or sisters; grandparents; adult grandchildren; and, finally, an adult friend or close relative.
"No one in a lower category can provide consent for health care if someone in a higher category has refused to consent to the proposed health care," Nelson said.
The third part of the directive gives the authorization that a patient's tissues or organs can be donated through what Nelson called "an anatomical gift."
Acquiring a directive is a fairly easy and simple process.
"If a person wants to get one, we offer it always to patients that come into the hospital," Nelson said. "That is one of the questions we ask: Would you like information about an advanced health care directive? If they say they do, a chaplain makes a point of going in."
While there is the demand for information, it sometimes goes no further than receiving the paperwork. Nelson said that "not as many as I think" actually complete the process of getting a health care directive.
"We have a number of persons that we will give information to, but the number that complete it while they're here is not real high," Nelson said. "I would say more persons should respond to the health care directive. If everybody in your family knows what you want and there are no questions or struggles, things will be OK. Once it is in writing, it really helps nail things down."
There is no fee for a health care directive to be completed with Trinity Hospital, Nelson said, noting that the directive, to become legal, needs to be witnessed by two persons or be authorized by a notary public. Information about the directives can be received from Trinity by calling 857-5000 and asking for a chaplain.
"We like to emphasize it really is the gift of love that we can give to our families to help them make decisions when death is imminent," he said.