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w>uGJ;[h.vDRwh>qdw>M>ogtusdRtusJ Karen Advance Directives Revised August 2014

Karen Advance Directives - CHI Health · 2020-02-26 · Mission The Mission of Catholic Health Initiatives is to nurture the healing ministry of the Church, supported by education

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Page 1: Karen Advance Directives - CHI Health · 2020-02-26 · Mission The Mission of Catholic Health Initiatives is to nurture the healing ministry of the Church, supported by education

w>uGJ;[h.vDRwh>qdw>M>ogtusdRtusJ

Karen Advance Directives

Revised August 2014

Page 2: Karen Advance Directives - CHI Health · 2020-02-26 · Mission The Mission of Catholic Health Initiatives is to nurture the healing ministry of the Church, supported by education

Mission

The Mission of Catholic Health Initiatives is to nurture the healing ministry of the Church, supported by education and research. Fidelity to the Gospel urges us to emphasize human dignity and social justice as we create healthier communities.

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Page 3: Karen Advance Directives - CHI Health · 2020-02-26 · Mission The Mission of Catholic Health Initiatives is to nurture the healing ministry of the Church, supported by education

zJtvH;uJF;c&HwX.w>td.ql.td.cVw>qg[H. (CHI  Health)   M.< AytX.vDRvXyu'due.yySRqgwz.tuvk>zJyuG>xGJtDR

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ew>td.ql.td.cshwuyReh.wuh>Arhwrh>qJ;usd;ACHI  Health  Ethics  Center:  

[email protected]  rhwrh>qJ;usd;A1=800=253=4368

 

                         

 

 

Page  1           pH.th;*Sftg,fAvHmw>td.ql.td.cVw>eJ.usJcgqlngwz. AI  ubsH;yRA1    

Page 4: Karen Advance Directives - CHI Health · 2020-02-26 · Mission The Mission of Catholic Health Initiatives is to nurture the healing ministry of the Church, supported by education

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Page  2           pH.th;*Sftg,fvHmw>td.ql.td.cVw>eJ.usJcgqlngwz. AI  ubsH;yRA2    

Page 5: Karen Advance Directives - CHI Health · 2020-02-26 · Mission The Mission of Catholic Health Initiatives is to nurture the healing ministry of the Church, supported by education

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Page 6: Karen Advance Directives - CHI Health · 2020-02-26 · Mission The Mission of Catholic Health Initiatives is to nurture the healing ministry of the Church, supported by education

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u[H;rl'gwoh rhwrh>vX=  

1) euoH.o&. rhwrh>ySRuG>xGJ ew>td.ql.td.cVtd.'D;w>ymzsgxD.w>b.o;

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2) euoH.o&.qXwJmvDRwH>0JvXetd.vXw>ulpg,gbsgeRwohvXRb.tywD>

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vXuuwdRw>'D;euoH.o&.'D;ecX.p;vXtrRw>qXwJmb.C;w>*h>w>usdRvXew>eJ.usJqd(Advance  Directives) tvHm

wDvHmrDtylR< AvXty.Ckm'D;ew>ymvkmymyORwz.< Aw>emwz.'D;ew>tJ.'d;wz.M.vDRI Aw>*h>w>usdR'D; vHmuGD.'dwz.vXvHm

tHRtylRM.urRpXReRvXw>uwdRoud;wz.tHRM.vDRI  

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vXe*D>ohzJeb.w>rRvDRwH>vXeqXwJmw>wz.tHRvXeeD>up>'.eJwohb.tcgM.vDRI

Page  4                      pH.th;*Sftg,fAvHmw>td.ql.td.cVw>eJ.usJcgqlngwz. AI  ubsH;yRA4  

Page 7: Karen Advance Directives - CHI Health · 2020-02-26 · Mission The Mission of Catholic Health Initiatives is to nurture the healing ministry of the Church, supported by education

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z.ttd.M.vDRI  tvHuFJ;c&HwX.vHmw>td.ql.td.cVw>eJ.usJcgqlngwz.  

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AAyD>&DtpdurDRvXew>td.ql.td.cVw>uG>xGJt*D>wbsDv>v> erRw>qXwJmohtywD> td.xJvJ. *hRoh0J< cDzsdwJ'k;oh.ng rhwrh>

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IAySRvXttd.qd;vXeH.-b.pu.uD>pJ.tylR= exk;uGHme (Durable  Power  of  Attorney) yD>&DtpdurDRvXew>td.ql.

Atd.cVohxJvXzJerRw>qXwJmohtywD>td.xJvJ.< 'D;vXusJ'fvJ.*hRtylR cDzsdw>qJ;usd;'D;ew>o;ql.vXeuxk;uGHm (Durable  

Power  of  Attorney) yD>&DtpdurDRvXew>td.ql.td.cVM.vDRI exk;uGHmevHmw>uGJ;ymw>M>og (Living  Will  Declaration)  

wbsDv>v>oh0Jb.xGJ'D;ew>rRw>qXwJmohtywD> rhwrh> eD>cdw>td.o;M.vDRI

Page  5                      pH.th;*Sftg,fAvHmw>td.ql.td.cVw>eJ.usJcgqlngwz. AI  ubsH;yRA5  

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Page 8: Karen Advance Directives - CHI Health · 2020-02-26 · Mission The Mission of Catholic Health Initiatives is to nurture the healing ministry of the Church, supported by education

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r h >,vd.b.y D >& DvXuuwJmuwD RM>, (Advance  Directives) tv Hmw Dv Hmr Dp h >u D ;{ g?  vX tJ.td.0. (Iowa) eH.-b.pu.(Nebraska)  tylRM. w>od.w>oDwtd.vX w>uvd.b.vXtpH;0JvX evd.b. yD>&Dw*RvX

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AAvHmwDvHmrDM.b.I AySRtk.o;xJw*RM. ub.rh> ySRvXtb.xGJ'D;ySRw*RvXtrRySJR vHmwDvHmrDM.vDRI

IAvXySRvXttd.vXeH.-b.pu.t[D.u0DRtylRM. = ySRtk.o;w*RpkmpkmM.tpSRuwX>to;eH.ub.td.0J 19 eH.< wb.rh>rg<

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AAySRrRw>qXwJmvX (eyD>&DvXtrRM> w>*h>w>usdRvXe*D> “Attorney-­‐in-­‐Fact”)vXtd.Ckm'D;e vHmwDvHmrD< rhwrh>w>tk.uDRw>td.

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Page  6                      pH.th;*Sftg,fAvHmw>td.ql.td.cVw>eJ.usJcgqlngwz. AI  ubsH;yRA6  

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Page 9: Karen Advance Directives - CHI Health · 2020-02-26 · Mission The Mission of Catholic Health Initiatives is to nurture the healing ministry of the Church, supported by education

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vXw>td.w>qd;tvD>tusJrh>0J _________________________________________________________,    

'D;vDwJpdteD.*H>wz.rh>0J = ([H.)_____________________  (vDwJpdpdmpk)_______________________  

'ftrh>,cX.p;vXtpH.nD.wJmw>< vXtb.w>oh.ngtDRvXvHmwDvHmrDtylRtHR'ftrh>, yD>&DvX tupH.nD.wJmM>

w>vX w>td.ql.td.cVt*D> ("Attorney-­‐in-­‐Fact  for  Healthcare  ")  M.vDRI

,[h.pd[h.urDR[h.vDRrl'g_____________________  vXtw>td.qd;vD>usJrh>0J  ____________________  

'D;ySRvXtvDwJpdeD.*H>rh>0J([H.)  __________________    (vDwJpdpdmpk)__________________  'f,ySRM>ogw>

ySRqXwJmw> (vXvHmwDvHmrDtHRtylRb.w>oh.ngtDR'ftrh>, yD>&DvX tupH.nD.wJmM> w>vX w>td.ql.td.cVt*D>

("Attorney-­‐in-­‐Fact  for  Healthcare  ")  zJySRvXtrHRzsgvXw>zDcd.w*Rrh>wvDRem rhwrh> wtJ.'d;rRw>qXwJmvX

tb.C;'D;,Rb.tcgM.vDRI

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cJ;w>vX,*D>vX,w>td.ql.td.cVw>uG>xGJ'D;w>ulpg,gbsgvXtymzsgxD.,vk>,yOR< ,w>pl>w>em'D;w>o;pJw z.<

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b. w>ulpg,gbsgtcgM.vDRI rhrh>vXtb.C;'D;,eD>o;w>td.ql.td.cV'D;w>ulpg,gbsgvX,rh>vd.b.tDRM.

(uG>w>vX vmtHR) wuh>=

A,wrRySJR (Advance  Directives) vHmwDvHmrDvDRqDvX,o;w>qdurd.w>td.ql.td.cV'D;,rh>vd.b.w>ul

AAAApg,gbsg vXwbsDtHR< ySRvXtrHRzsgzJtHR urRw>qXwJmvX w>ulpg,gbsg ,o;w>qdurd.w>td.ql.td.cVvX ,

AAAvd.b.tDR M.vDRI

A,rRySJR (Advance  Directives) vHmwDvHmrDvDRqDvX,o;w>qdurd.w>td.ql.td.cVw>uG>xGJ'D;w>ulpg

AAA,gbsgvX tvD>td.M.vDRI vHmuGJ;'dtd.0JzJ= ___________________________________________.  

A

(wd>eD.= wJoud;w>'D;ew>td.ql.td.cVySRuG>xGJw>tu%l>tySRrRw>zdzJ erh>tJ.'d;rRySJRw>*h>w>usdRvX (Advance  

Directives) vHmwDvHmrDtylRvX erh>vd.b.eD>o;w>qdurd.w>td.ql.td.cVw>ulpg,gbsgtcgM.wuh>I)

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___________________________________________________________________________________  ___________________________________________________________________________________  

___________________________________________________________________________________  (wd>eD. = cDzsdvXySReD.up>tw>cGJ;w>,mtw>od.w>oDtCd< w>uG>xGJw>td.ql.td.cVtvD>wz.uvd.b.w>rRySJR

vHm HIPAA w>[h.pd[h.urDRtvHmuGD.'dvX u&RvDR ew>td.ql.td.cVtw>*h>w>usdRwz.t*D>M.vDRI)  

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w>eJJ.usJvXvmwz.vXtb.C;'D;w>uG>xGJ,w>td.ql.td.cV'D;w>ulpg,gbsgvX,vd.b.wz. (wdReD.w>CkxX

vXvmtHRwcgwuh>) =

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AAAb.w> qXwJmtDRvX,vD>vXtb.'d,w>M>bsK;wz.< w>emwz.'D;w>vX,tJ.'d;wz.tcg{dRM.vDRI

A,td.'D;w>eJ.usJvDRqDvXty.Ckm'D;w>*h>w>usdRrRvXySJRxD.w>vX,[h.b.vHvXw>eJ.usJqdtvHmwDvHmrDtylR<

AAA'D;eJ.vdRvXw> eJ.usJwz.ub.w>qdurd.xHq;tDRzJw>qXwJmw>vX,vD>M.vDRI

ySRrRvXySJRvHmwuGD.qJ;vDRrHR__________________rk>eHR A____________________   A

Page 10: Karen Advance Directives - CHI Health · 2020-02-26 · Mission The Mission of Catholic Health Initiatives is to nurture the healing ministry of the Church, supported by education

w>eJ.usJqdtvHmwDvHmrD (ubsH;yR2 AvX A4 AubsH;yRtusg)

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Declaration)    vXtwJzsgxD.vX ,uoH.o&. rhwrh> ySR[h.w>uG>xGJw>td.ql.td.cV 'D;,cX.p;vX urRw>qXwJm

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tusdRtusJwz.M.vDRI

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 ,CkxXvX ,wrRySJR w>ymzsgxD.w>b.o;zJtd.rl'H;tcg (Living  Will  Declaration)    vXw>qXuwD>cJtHR'fb.<

AAA'D;eJ.vDR,uoH.o&.< ySR[h.w>uG> xGJw>td.ql.td.cVt*Rwz.'D;cX.p;vXurRw>qXwJm(wz.) vXuqXwJm

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AAA,w>M>bsK;wz.< ,w>emwz.'D;,w>tJ.'d;wz.M.vDRI

   ,CkxXvXurRvXySJRw>ydmxGJvXw>td.rltd.*JRtw>wJzsgxD.vXw>qXuwD>cJtHRM.vDRI    

AAAA0Ho;plRCkxXw>CkxXvXvmwz.tHRwuh>=

AAvXySRtd.qd;vX t.0. wz.t*D> = ,eJ.vDR,uoH.o&.'D; ySRvX[H;M>rl'gvX uuG>xGJ ,w>td.ql. td.cV ub.w>

AAAAeJ.vdRM>tDRvX ,w>vd.b.vX ,ymzsgxD.wz.M.vDRI ,rh>td.vX w>td.o;zJ w>ulpg,gbsg,R rh>wM>rhwrh>w>

AAA,gbsg,Rrh>wohvXRb.'D; tpXrhrh>0J vX,upl;uGHm,o; vXw>qXuwD>w,HmwrDRb.tCd rhwrh> ,rh>weD.ol.eD.

AAAo; rhwrh> w>ulpg,gbsgrh>wM>vXRb.tCd< ,wtJ.'d;vX w>uok;xDxD.,w>td.rl cDzsdvX w>pl;uguoH.tusdRt

AAAusJvXuxk;xDxD.,o;orlb.M.vDRI ,rh>EkmvDRy.CkmvXw>qXwJmvX w>uG>xGJ ,w> td.ql.td.cV t*D>rh>wohb.

AAAtCdwcD< ,eJ.vDR ,uoH.o&.vXuG>xGJ,R vXtokw[h. rhwrh> xk;uGHm w>[h. uoH.tusdRtusJvXuxk;xDxD.,

AAAo;orlvX ,rR,HmxD.w>qXuwD>vX ,upl;uGHm,o;t*D>'D; wrh>w>vX trRudn> rhwrh>rRobVxD.uGHm,RvXw>

AAAql;w>qgwbsDtHRt*D>b.tCdM.vDRI

AAySRtd.qd;vXeH.-b.pu. wz.t*D> = ,eJ.vDRvX ,uoH.o&.'D;ySRw*Rv>v>vX [H;M>rl'gvX w>uG>xGJ,w>td.

AAAql.td.cV ub.w>eJ.usJvX,w>vd.b.vX ,b.ymzsgxD.wz.M.vDRI ,*H>,bgrh>pSRvDRwkRvX,[l;0;wM>weD.

AAAol.eD.o;tywD> rhwrh> w>ulpg,gbsgwoh rhwrh> w>rRvdRbSDb.uhRwohvXmb.ywD><'D;,rh>wpl;uguoH.rRpXRo;

AAAorltusdRtusJb.M.< ,u< vXuoH.o&.tw>xH.tylR< upl;uGHmo;vX w>qXuwD> w,HmwrDRb.tCd'D;,qX

AAAwJmw>b.xGJw>ulpg,gbsg,Rt*D>rh>wohvXRb.tCdM.< ,eJ.vDRvX ,uoH.o&.< 'fttd.0JvX oJp;w>cGJ;w>,m

AAAvXw>ulpg,gbsgwohvXRb. 3 tw>od.w>oDtylR  (Rights  of  the  Terminally  Ill  Act) < vX,w[h. rhwrh>

AAAuxk;uGHmw>rRpXRo;orltusdRtusJzJ twrh>w>vXurRudn>xD.,R rhwrh> rRbsguhR,w>qgb.tCdM.vDRI

AAvXySReD>w*Rt*D> = ,tJ.'d;eDRvDRw>*h>w>usdRydmxGJwz.vXb.C;,w>tJ.'d;vX w>rRpXRo;orltusdRtusJwz.

AAArhwrh> tusdRtusJ'f ,w>ymzsgxD.w>b.o;zJtd.rl'H;tcg (Living  Will  Declaration)  tDRtylRM.vDRI

___________________________________________________________________________________    ___________________________________________________________________________________    ___________________________________________________________________________________    

___________________________________________________________________________________    ___________________________________________________________________________________    ___________________________________________________________________________________    

___________________________________________________________________________________    ___________________________________________________________________________________    ___________________________________________________________________________________    

   

        ySRrRvXySJRvHmwuGD.qJ;vDRrHR__________________rk>eHR A____________________    

w>ymzsgx

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Page 11: Karen Advance Directives - CHI Health · 2020-02-26 · Mission The Mission of Catholic Health Initiatives is to nurture the healing ministry of the Church, supported by education

w>[h.w>M>ogzJw>oH0HRtvD>cHtvHmwDvHmrD (ubsH;yR 3 vX 4)

Alegent Creighton Health Advance Directives Booklet | Page 9

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td.ql.td.cVtvHmwDvHmrDwz.tzDcd.ohxD&DRwbsDzJ ,rRw>qXwJmvX ,eD>up>'.0Joh'D; zJ,td.'D;w>ohw>b.vX

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,uoH.o&. ‘D; ySR[h.vDRw>td.ql.td.cVw>uG>xGJw>rRpXR(wz.) t*Rtw>qJ;vDRrHR = (w>tk.o;)

,uG>u’guhR,w>*h>w>usdRvX w>eJ.vDRtusdRtusJqlngwywD> (Advance Directives) vXvHmwDvHmrDtHRtylRvHI

uGJ;vDRrHR = qJ;vDRrHR = eHRoD =

uGJ;vDRrHR = qJ;vDRrHR = eHRoD =

uGJ;vDRrHR = qJ;vDRrHR = eHRoD =

ySRrRw>qXwJmvX,cX.p; (wz.)tw>qJ;vDRrHR (,?yD>&D/) (w>tk.o;) ,uG>u’guhRw>*h>w>usdRvX w>[h.w>M>ogzJw>oH

0HRtvD>cH (Advance Directives) vHmwDvHmrDtHRtylRvHI

uGJ;vDRrHR = qJ;vDRrHR = eHRoD =

uGJ;vDRrHR = qJ;vDRrHR = eHRoD =

ySRrRvXySJRvHmuGD.’dtHRtrHRcD.xH; eHRoD =

t J .v H ;u J c& H w X .v H mw>t.d q.l t.d c V w>e J .u s J cgq nl gwz. (Alegent Creighton Health Advance Directives Booklet)

Page 12: Karen Advance Directives - CHI Health · 2020-02-26 · Mission The Mission of Catholic Health Initiatives is to nurture the healing ministry of the Church, supported by education

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Alegent Creighton Health Advance Directives Booklet | Page 10

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vHmrDtHRtySRyXqSXw> rhwrh> ySRrRw>zdwz.M. wb.uJySRtk.to;tgM>w*Rb.vDRI ,bd;b.oh.ngvX =

ySRtHRrRvXySJRvHmwDvHmrDvXyoh.ngtDRvHM.vDRI ySRtHRqJ;vDRrHRqlw>rRvXySJRvHmwDvHmrDtHR rhwrh> tX.vDRvXt’d;M>vH (t0JydmcGgAydmrk.) w>qJ;vDRrHRvX w>[h.w>M>ogzJw>oH

0HRtvD>cH (Advance Directives) tvHmwDvHmrDzDcd. vXyw>tJ.’d;tylRvHM.vDRI y0J< rhwrh> ySRw*R tuoH.o&.vX tulpg,gbsgw> eDw*Rr;wrh>ySRvX tuuJcX.p;vX trRw>qXwJm ( ,?yD>&D/) b.M.vDRI ywkRxD.xD.b;’D;w>eJ.vDRwz.vXySRtk.o;wz.t*D>’fw>qDvDRympXRtDRvX uD>pJ.w>od.w>oDtod;vHM.vDRI

vHmtulmtHRub.w>rRvXySJRtDRvXySRtk.to;vXttd.qd;vX eH.-b.p.c. (Nebraska) ‘D;tJ.td.0.(lowa) wz.vDRI ySRtk.o; 1 uGJ;vDRrHR = qJ;vDRrHR = eHRoD = ySRtk.o; 2 uGJ;vDRrHR = qJ;vDRrHR = eHRoD =

vHmtulmtHRub.w>rRvXySJRtDRvX ySRtk.to;vXttd.qd;vX tJ.td0. (lowa) tpSRuwX>w*R{dRM.vDRI ,bd;b.oh.ngtgxD.vX tJ.td0. (Iowa) tw>od.w>oDb.C;w>[h.w>ur.b.C;w>wJw>wwDwvdRtzDvm,RtHR,wb.

xGJ'D;ySRvXtrRySJRvHmwDvHmrDtHRvX oGH.xH< cDzsdw>xD.yS>< rhwrh> w>vk>zdM>tDRvX'H>u&H.oXywD>wywD> tw>&hvdmb.xGJtylRb.

b.M.vDRI ySRtk.o; 1 ‘D;Arhwrh> 2I qJ;vDRrHR = eHRoD =

vHmtulmtHRub.w>rRvXySJRtDRvX ySRtk.to;vXttd.qd;vX eH.-b.p.c. (Nebrasaka) {dRM.vDRI

,ym*X>ymusXRph>uD;vX (t0JydmcGgAt0Jydmrk.) bd;b.oh.ng0JvX w>rRzd;oJp;vHmwDvHmrDtHR ub.rh>'f (t0JydmcGgAt0Jydmrk.)

tw>o;ql.'D;tw>b.o;tzDcd.M.vDRI ySRtk.o; 1 qJ;vDRrHR = eHRoD = ySRtk.o; 2 qJ;vDRrHR = eHRoD =

ySRrRvXySJRvHmuGD.’dtHRtw>qJ;vDRrHR = eHRoD =

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w>rRvXySJRxD.w>*h>w>usdRb.C;’D;

,w>tJ.’d;vXw>td.ql.td.cV’D;w>ulpg,gbsgwz. (ubsH;yR 1 vX 2)

Alegent Creighton Health Advance Directives Booklet

,R< , zJrk>eHRrk>oDtHR tJ.’d;[h.vDR w>rR

vXySJRxD.w>*h>w>usdRvXvmtHRql ,ySRrRw>qXwJm(wz.)vX,cX.p; (, ?yD>&D/)< ,uoH.o&.’D;ySRvXt[h.w>td.ql.

td.cVw>uG>xGJw>rRpXRt*Rwz.< ‘D;,ChvXw>*h>w>usdRtHRub.w>qdurd.uG>xHuG>q;tDRzJ w>rRw>td.ql.td.cVw>uG>xGJ’D;w>ul

pg,gbsgw>qXwJmwz.vX,cX.p;M.vDRI ,e>yX>vX t0Joh.urRw>t*hRuwX>vX uvlRydmrRxGJw>*h>w>usdRvX w>rRtusdRtusJ<

vXtw>qdurd.w>ymol.ymo; vXtoh.ngw>*hRw>w*hRtqX < ‘D;vXtzd;oJp;wz.vXttd.wz.< Ckm’D; w>qXwJm’fM.od;wz.

w[h.w>uDw>cJvXu’k;td.xD. w>b. ‘db.xH;vX,R rhwrh> ySRt*Rwz.b.M.vDRI

,w>*h>w>usdRxD&DRvX,tJ.’d;vXeuoh.ngb.C;’D;,R =

w>*h>w>usdRb.C;w>yXqSXw>qgtyeD.’D;w>yXRCmw>ql;w>qg = (t’d< ,w>ymzsgxD.w>ulpg,gbsgvXt-uX;tb.< w>uXRCmw>vX

w>yvD>y’Do;‘D;w>ulpg,gbsg w>ql;w>qgAw>qgtyeD.wz.< w>rRpXRvX,xH.M>vXtulpg,gbsg,w>ql;w>qg’D;w>qgtyeD.t*Rwz.)

w>*h>w>usdRb.C;’D;w>tD.w>tD’D;w>tD.M>*H>M>bg (t’d< w>tD.w>tD’D;w>xHw>edvX,tD.bJ< ,w>tJ.’d;tgM>w>t*RvXtb.C;’D;uoH.

uoDtw>rRpXRvXw>tD.M>*H>M>bg’D;w>rRpk.pD. xD.o;< rhwrh> ?w>[h.’k;tD.w>tDw>tDvXyDRbd/)

w>*h>w>usdRb.C;’D;w>td.ql.td.cVw>uG>xGJ’D;w>ulpg,gbsgtuvkmt*RvXw>tJ.’d;tDRwz.M.vDRI (t’d< w>ulpg,gbsgvXtuvDwz.<

‘ftrh> w>pH>< w>ulpg,gbsgvXw>eXrleXqSDwz.< rhwrh> w>uG>xHqdurd.w>u,Du,DvXw>bO.w>bSD.tylR)

w>*h>w>usdRb.C; ,tJ.’d;w>tH;xGJuG>xGJvX,w>td.ql.td.cVw>uG>xGJ’D;w>ulpg,gbsgw>vd.b.wz.t*D>< Ckm’D;w>tH;xGJuG>xGJvX (t’d<

vX[H.< vXw>qg[H.tylR< vXw>uG>xGJvDRwH>vDRqJ;tyD;tvDwz.tylR< cDzsdw>qg[H.vXySRvXtbl;uoHoh.wz.t*D>tu%l>u&X)

t J .v H ;u J c& H w X .v H mw>t.d q.l t.d c V w>e J .u s J cgq nl gwz. (Alegent Creighton Health Advance Directives Booklet) | ubsH;yR 11

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w>rRvXySJRxD.w>*h>w>usdRb.C;’D;

,w>tJ.’d;vXw>td.ql.td.cV’D;w>ulpg,gbsgwz. (ubsH;yR 1 vX 2)

Alegent Creighton Health Advance Directives Booklet | Page 12

w>*h>w>usdRb.C;’D; o;orlw>td.uXtd.cd;w>ulpg,gbsgwz.vX b.oh.oh.rR,HmrReD.xD. w>bl;uoHw>ulpg,gbsgtusdRtusJwz. (t’d<

uwD>,Hmw>uog’X (ventilator) yD;vDvXtrRpXR,w>ogxD.ogvDR< uoH.rRoHw>qgC>vX tulpgw>b.*mwz.’ftrh> yod.w>ck.b.)

w>vXt[JpdmM>,Rw>rkmol.rkmo; = (t’d< w>xkuz. rhwrh> w>bl.w>bgtvHm{dRvJ>{dRwz.vX,b.o;< ySRvX,tJ.tDRuGHtDRwz.

tw>*DR< ,.vk;vDRqD rhwrh> w>uH;nmtuh< w>ol.0H.o;qX rhwrh> w>wJylvXeb.ol.b.o;wz.< ySRvXetJ.’d;ttd. vXecd.eCXR

‘D;w>vXetJ.’d;ttd.vXecd.eCXRwz.)

w>eJ.usJvDRwH>vDRqJ;b.C; = w>[h.rRbl.vDR uh>*DR’GJ< xH;%SL< rJmcsH< ‘D; eD>cduh>*DR =

_ w>tJ.’d;vXw>orHord;uG>ySRoHtpd.’fod;uoh.ngb.ySRoH’fvJ.t*h>wz. =:

w>tJ.’d;vXw>cl.vDRbgvDR rhwrh> w>uk>CdpDrh.wz. =: w>cl.vDRySRohtw>&J.w>usJRwz.Aw>oh.eD.xD.uhRySRvXtvJRylRuGHm[D.cd.trl; =:

,ymol.ymo;vX w>tHRt&h’d.r;vX w>uwJoud;b.C;w>*h>w>usdRvXvHmwDvHmrDtHRtylR’D; ySRvXty.CkmvX w>rRw>qXwJmwz.vX

tb.xGJ’D;,w>td.ql.td.cVw>uG>xGJ’D;w>ulpg,gbsgw>vd.b.wz. zJ,rRw>qXwJmvX,eD>up>’.,Jt*D>wohb.tcgM.vDRI rh>vX

w>*h>tHRtCd< (wdReD.vDRw>vXtb.xGJ’D;eRwrHRrHRvXvmtHRwuh>) = ,wX.yD.wJoud;w>*h>w>usdRtHR’D;ySRrRw>qXwJm(wz.) vX,cX.p; =

,wX.yD.wJoud;w>*h>w>usdRtHR’D;uoH.o&.’D;ySR[h.w>td.ql.td.cVw>uG>xGJtw>rRpXRvXvmwz. =

,wX.yD.wJoud;w>*h>w>usdRtHR’D;ySRvXvmwz. (t’d< [H.zdCDzdt*Rwz.< wHRoud;wz. rhwrh> *h>*D>tlw>qJ;usd;qJ;usXcX.p;vXtuuJM>cX.

p;vX,vD>’f ‘ftrh>ySRvXtrRw>qXwJmvX,cX.p;vXt’d;oMRxD.to;vX w>td.ql.td.cVw>uG.xGJ’D;w>ulpg,gbsgw>qXwJmwz.tzDcd.)

rRvDRwH>vXebs;pJCkmw>rRvXySJRxD.w>*h>w>usdRtvHmuGD.’dql e w>[h.w>M>ogzJw>oH0HRtvD>cH (Advance Directives) vHmwDvHmrD

wz.’D; [h.vDRw>rRvXySJRxD.w>*h>w>usdRtHRtuGJ;’dql euoH.o&.< ySRvXtrRw>qXwJmvXecX.p;(wz.) ‘D;ySR[h.w>td.ql.td.cV

w>uG>xGJw>rRpXRwz.ttd.wuh>I

ySRrRvXySJRvHmuGD.’dtHRqJ;vDRrHR = eHRoD = ubsH;yR 12 | tJ.vH;uJc&HwX.vHmw>td.ql.td.cVw>eJ.usJcgqlngwz. (Alegent Creighton Health Advance Directives Booklet)

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Alegent Creighton Health Advance Directives Booklet

Alegent Creighton Health Advance Directives Booklet | Page 13

w>[h.ul.[h.z;vXw>wX.yD.wJoud;w> b.C;’D; w>[h.w>M>ogzJw>oH0HRtvD>cH

(ADVANCE DIRECTIVES) t*D>

ewJoud;w>’D;euoH.o&.< ySR[h.w>td.ql.td.cVw>rRpXRt*Rwz.< ySRvXtrRw>qXwJmvXecX.p;(wz.) ‘D; ySRvXtbl;bl;wH>wH>

’D;eRwz. b.C;’D;ew>tJ.’d;vXw>td.ql.td.cVw>uG>xGJ’D;w>ulpg,gbsgwz.M. rh>w>vXt&h’d.0J’.M.vDRI b.q.oemuh< ep;

xD.w>wX.yD.wJoud;w> wz.tHRuuDcJvXe*D>M.vDRI w>[h.ul.vXvmwz.tHR uuJxD.w>rRpXRvXe*D>zJep;xD. w>wX.yD.

wJoud;w>wz.tHRtcg oh.oh.M.vDRI

w>wX.yD.wJoud;w>’D;ySRrRw>qXwJmvXecX.p;(wz.)’D;ySRvXtbl;bl;wH>wH>’D;eRwz. zJewJoud;w>’D;ySRrRw>qXwJmvXecX.p;(wz.) ’D;ySRvXtbl;bl;wH>’D;eRwz.M.< *kmusJ;pX;p;xD.wJw>uwdRvXeub.p;xD.wJvXvm

wz.tHR=

ywwJoud;b.C;’D; ,w>tJ.’d;vXw>td.ql.td.cVw>uG>xGJ’D;w>ulpg,gbsgwz.eDwbsDb.< ‘D;,b.,d.vXewoh.ngw>uG>xGJ

tuvkmrEkRvX,tJ.’d;b.M.vDRI erh>b.rRw>qXwJmvX,*D>M.< ,wtJ.’d;eol.ud>o;*DRw>b.I tCd,uxXEkmvDR ,w>tJ.

’d;wz.vXvHmuhtvdR’D;,tJ.’d;wJoud;w>oh.wz.tHR’D;eRM.vDRI

,uoH.o&.wJvX ,w>qgM.w>ulpg,gbsgtDRwM>b.I ,tJ.’ d;qXwJmvXw>rEkRurRto;vXcHwywD>< ‘D;,tJ.’d;w>uG>xGJ

tuvkm‘fvJ.M.vDRI yuwJoud;b.C;’D;w>vX,tJ.’d;tDRwz.M.vDRI

p;xD.vX (,’Dbl;’DwH> rhwrh> wHRoud;wH>eD.) oHM.< ,qdurd.,tJ.’d;w>rEkR zJ,rk>eHRcHuwX>[JwkRtd.,RvHtod;M.vDRI ,oh.

ngvXuDcJvX,uwJw>*h>tHR< b.q.,tJ.’d;vXeuoh.ngb.C;,w>tJ.’d;vXw>td.ql.td.cVw>uG>xGJ’D;w>ulpg,gbsgM.

vDRI w>tHRrh>0Jw>[h.vX,tJ.’d;[h.eR ‘fod;wvd.eqdurd.w,mvX ,tJ.’d;w>rEkRvJ.b.M.vDRI

eoh.ng{g< ‘feo;yS>xD.tod;< eqdurd.b.C;w>vXevd.&J.usJRtDRwz.vXtvD>tusJb.b.M.vDRI vX,*D>M.< tusgwrHR rh>0J

w>td.ql.td.cVw>uG>xG JM.vDRI ,qdurd.wh>w>tgb.C;w>*h>tHR< ‘D;,rRvXySJR,J’. w>eJ.vDRtusdRtusJqlngwywD>tvHmwD

vHmrDvX ,wJb.,uoH.o&.wz.‘D;ySRrRw>qXwJmvX,cX.p;(wz.) ‘D;w>uG>xGJ’D;w>ulpg,gbsgtuvkmrEkRvX,tJ.’d;tDR

M.vDRI ,tJ.’d;wJoud;w>’D;eRb.C;w>tHR ‘fod;eqXwJmpXR,Rw>uohvDRwH>vDRqJ;vX w>urRto;’f,w>tJ.’d;tod;M.vDRI

w>wX.yD.wJoud;w>’D;euoH.o&.’D;ySR[h.w>td.ql.td.cVw>uG>xGJwz. zJewX.yD.wJoud;w>’D;ew>tJ.’d;vXw>td.ql.td.cVw>uG>xGJ’D;ew>ulpg,gbsgwz.’D;euoH.o&.’D;ySR[h.w>td.ql.td.cVw>uG>xGJ

w>rRpXRt*Rwz.tcg< rRvDRwH>vX =

rXySRwJe>yX>eRb.C;’D; w>CkxXw>td.ql.td.cVw>uG>xGJ’D;w>ulpg,gbsgvXewe>yX>tDRwz.wuh>I

wJoud;b.C;’D; w>ok;usJR&J.usJRw>ql;w>qgtw>CkxXwz.wuh>I

‘k;oh.ngeuoH.o&.vX erRvXySJR ew>eJ.vDRtusdRtusJqlngwywD>tvHmwDvHmrDwuh>I

rRvDRwH>vXeuoH.o&. ‘D; ySR[h.w>td.ql.td.cVw>uG>xG Jw>rRpXRwz. u[h.eRw>td.ql.td.cVw>uG>xGJ’D;w>ulpg,gbsgvX

etJ.’d;wz.’D;CkxH.M>w>CkxXwz. zJt0Joh.[h.eR w>rRpXRvXetJ.’d;wz.rh>woh cDzsdvXoJp;w>od.w>oDwyR< vXySR*hR-uX;

rR< rhwrh> eD>up>tw>*h>tCdwrHRv>v>tcgM.wuh>I

[h.vDR ew>eJ.vDRtusdRtusJqlngwywD> vXerRvXySJRtDRtuGJ;’dM.wuh>I

t J .v H ;u J c& H w X .v H mw>t.d q.l t.d c V w>e J .u s J cgq nl gwz. (Alegent Creighton Health Advance Directives Booklet) | ubsH;yR 13

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w>oHuG>wz.vX b.oh.oh. etJ.’d;oHuG> euoH.o&. ‘D; ySR[h.w>td.ql.td.cVw>uG>xGJw>rRpXRt*Rwz. =

rh>ewJoud;w>’D;,R’D;ySRvXtbl;bl;wH>wH>’D;,Rwz. vdRvdR’D;ysDysDzsgzsgb.C;’D; ,w>ql;w>qg’D; ,w>td.ql.td.cVw>uG>xGJ

’D;w>ulpg,gbsgtw>CkxXwz.uoh{gI

rh>,ub.rR w>td.ql.td.cVw>uG>xGJ ‘D; w>ulpg,gbsgw>qXwJmwz.’fvJ.< ‘D;rh>e[h.ul.[h.z;,R’D; ySRvXtbl;bl;wH>wH>

’D;,Rwz.vXw>rRw>qXwJmwz.tHRuohrEkRwrHRvJ.I

w>rh>qg,Re;e;uvJm rhwrh> w>rh>wrkmwvRM. rh>eurRw>rEkRwz.vJ.I

rh>eu’k;oh.ng zJw>ulpg,gbsgtw>rRw>ywkm ‘fod;,[H.zdCDzd’D;,R rRw>qXwJmt-uX;tb.vXw>uG>xGJvX,w>td.rl

tuwX>wz.t*D>uoh{gI

w>wX.yD.wJoud;w>’D;ySRt*Rb.C;’D;t0Joh.tw>tJ.’d;vXw>td.ql.td.cVw>uG>xGJ’D;w>ulpg,gbsgwz.

ewX.yD.wJoud;w>b.C;’D;ew>tJ.’d;vXtd.ql.td.cVw>uG>xGJ’D;w>ulpg,gbsgwz.rh>0HRud;rHR’J;tvD>cH’.vJm< eutd.vX w>td.o;vX

etJ.’d;wJoud;w>’D;ySRvXtbl;bl;wH>wH>’D;eRwz.b.C;’D; t0Joh.tw>tJ.’d;vX w>td.ql.td.cVw>uG>xGJ’D; w>ulpg,gbsgtylRM.vDRI

zJetJ.’d;wJoud;w>’D;ySRw*R*Rb.C;’D; t0Joh.tw>rRvXySJR w>eJ.vDRtusdRtusJqlngwywD> tvHmwDvHmrDwz.tcg< qdurd.w>vX

vmoh.wz.tHR<

CkxXw>qDvDRymvDRvXt-uX;tb. = &J.usJReurR w>wX.yD.wJoud;w>vX w>bO.w>bSD.tylR< zJw>vD>w>usJvXtrkmtck.vX

ewJoud;w>uohbH.bH.bXbX’D;wtd.’D;w>}wDrRwHmwmeDwrHR

w>ChcGJ; = ew>ChhcGJ;vXeuwX.yD.wJoud;b.C;w>*h>tHR ‘k;eJ.ew>oh.ngymuJ ySRt*Rtw>qdurd.< ‘D;etd.uwJm uwDR

eo;vXeu’due. t0Jtw>tJ.’d;vX w>td.ql.td.cVw>uG>xGJ ‘D; w>ulpg,gbsgwz.M.vDRI w>[h.ul.tusJweDRvXew>ChcGJ;

t*D> =

?,tJ.’d;wJoud;w>’D;eR b.C;’D;w>*h>vXzJeql;eqgeD>eD>tcg< etJ.’d;w>uG>xGJeR’fvJ.vDRI rh>uohuD;{gI/

?zJetd.wql.tcg< ,ysHRvX,woh.ngb.zk;etJ.’d;w>uG>xGJ’fvJ.wuvkmvJ. b.M.vDRI rh>ywJoud;b.C;’D;w>*h>tHR

tcJtHRuoh{gI yrh>wJoud;b.w>M. ,o;urkmxD.vDRI/

oh.ngw>vXerk>v>uG>pdtDR =xDbdM.oh.eD.xD.vX ep;xD. w>wX.yD.wJoud;w>tHR rh>vX eymol.ymo;’ D;ySR*Rtw>td.

rkmtd.yXRM.vDRI w>urRw>wX.yD.wJoud;w>wz.tHR nDEk>rh>w>vXtuDcJ0J’.M.vDRI ysJySR*RvXuymvDRw>vD>w>usJM.wuh>I

*kmusJ;pX; yXRCmw>&hvdmrkmvdm’D;w>oh.ngymuJvdmo;w*R’D;w*RvX w>wX.yD.wJoud;w>’DwuwD>ngtylR cDzsdymzsgxD. ew>

o;pJ< w>tJ.w>uGH‘D;w>b.,d.b.bDwz.M.wuh>I

w>uGJ;eD.wz. = ubsH;yR 14 | tJ.vH;uJc&HwX.vHmw>td.ql.td.cVw>eJ.usJcgqlngwz. (Alegent Creighton Health Advance Directives Booklet)

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Alegent Creighton Health Advance Directives Booklet

w>CkxH.oh.ngevk>eyOR’D;ew>tJ.’d;wz. w>pH;qXw>oHuG>wz.tHR b.oh.oh.uuJxD.w>rRpXR rh>vXetd.uwJmuwDReo;vXeurR ew>tJ.’d;vX w>td.ql.td.cVw>uG>xGJ ‘D;

w>ulpg,gbsg vXw>uoh.ngb.tDRcDzsd w>eJ.vDRtusdRtusJqlngwywD> tvHmwDvHmrDM.vDRI

,tJ.’d;vXw>uoh.eD.,R’fvJ.I

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w>uG>o}wJRwz.

American Bar Association. (2011). ABA Commission on Law and Aging Tool: How to Select Your Health

Care Agent or Proxy. Retrieved June 20, 2011 from http://www.americanbar.org/groups/law_aging/resources/consumers_toolkit_for_health_care_ advance_ planning.html.

Center for Practical Bioethics. (2012). Caring Conversations: Making Your Healthcare Wishes Known. Retrieved June

25, 2012 from http://www.practicalbioethics.org/resources/caring-conversations.html.

Harrold, J. & Lynn, J. (1999). The Handbook for Mortals: Guidelines for People Facing Serious Illness.

Oxford University Press: New York, NY.

Iowa Legislature. (2011). Iowa State Statute 144A-1 Life-sustaining Procedures Act. Retrieved June 20, 2011 from http://search.legis.state.ia.us/NXT/gateway.dll?f=templates&fn=default.htm.

National Hospice and Palliative Care Organization (NHPCO). (2010). Caring Connections: How to Talk

with Your Healthcare Provider. Retrieved June 20, 2011 from

http://www.caringinfo.org/i4a/pages/index.cfm?pageid=3281.

National Hospice and Palliative Care Organization (NHPCO). (2011). Caring Connections: Talking with Others about their End-of-Life Wishes. Retrieved June 20, 2011 from http://www.caringinfo.org/i4a/pages/index.cfm?pageid=3282.

Nebraska Legislature. (2011). Nebraska Revised Statute 30-3402: Terms Defined. Retrieved June 20, 2011 from http://nebraskalegislature.gov/laws/statutes.php?statute=30-3402.

Nebraska Legislature. (2012). Nebraska Revised Statute 30-2209: General Definitions. Retrieved June 25, 2012

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Alegent Creighton Health Advance Directives Booklet ubsH;yR 17

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