Medical Directive Consultation Form

Medical Directives express your preferences for medical care in the event that you cannot communicate your wishes, and it legally binds your healthcare providers to follow your orders. You can specify what care you want provided or withheld if you are diagnosed to have a terminal illness or to be in a permanent coma, and you can name an agent to ensure that your wishes are followed.

The following terms have special meaning when used in your healthcare Directive.

• Terminal condition means a condition that will cause imminent death, or to a reasonable degree of medical certainty, is hopeless unless artificially supported through the use of life-sustaining procedures. The condition must be confirmed by a physician who is qualified and experienced in making such a diagnosis.
• Permanent coma means a condition that, to a reasonable degree of medical certainty:
  •will last permanently, without improvement, and
  •in which there is no cognitive thought, sensation, purposeful action, social interaction and awareness of self and environment.
  In addition, the condition must have existed for a period of time sufficient to make such a diagnosis, and must be confirmed by a physician who is qualified and experienced in making such a diagnosis.
• Life-prolonging treatment means any medical treatment, procedure or intervention that, in the judgment of the attending physicians, would only serve to prolong the dying process where the patient has a terminal illness or injury, or would serve only to maintain the patient in a condition of permanent unconsciousness. These procedures include assisted ventilation, cardiopulmonary resuscitation, renal dialysis, surgical procedures, blood transfusions and the administration of drugs and antibiotics.
  
• Artificially administered food and water -- also called nutrition and hydration -- means administering food and water through a tube or intravenous line, where the recipient is not required to chew or swallow voluntarily.
• Comfort care means any care that doctors think is necessary to make a patient comfortable or alleviate pain. It does not include artificially-administered food and water.

We need the following information to prepare your Medical Directive: