Decisions about Your Care
Massachusetts law requires that, as a patient, you have the right to make decisions about your medical care, to accept or refuse medical or surgical treatments, and to appoint a health care agent by completing a Health Care Proxy. It is the policy of Beth Israel Deaconess Hospital–Needham (BID–Needham) to respect all patients' rights of self-determination to the fullest extent permitted by law. To carry out this policy, it is important that you read the following pages carefully, and ask your doctor any questions you may have about your care.
The Right to Accept or Refuse Treatment
As an adult patient receiving medical care in Massachusetts, you have the right to accept or refuse medical or surgical treatment. You also have the right to choose another person (who may or may not be a family member) to act as your agent or proxy for making medical decisions in the event you become unable to understand and appreciate the nature and consequences of health care decisions, including the benefits and risks of and alternatives to any proposed health care, and to reach an informed decision for yourself. Your agent will have legal authority to make decisions for you with your doctor. If you do not choose an agent, your family may be asked to make decisions based upon what they believe you would want done. If you have no family, or if there is a disagreement about what treatment you would want, a court may be asked to appoint a guardian to make decisions on your behalf. Any person, whether healthcare agent or other representative making a decision on your behalf, must base his or her decisions upon what he or she believes you would want done.
Your right to refuse treatment (whether exercised by you or your agent, family, or court-appointed guardian) includes the right to refuse life-sustaining treatments and procedures. In patients who have sudden cardiac or pulmonary arrest, cardiopulmonary resuscitation (CPR) is performed unless a Do Not Resuscitate (DNR) order is given.
A DNR is an order written by a physician specifying that no CPR efforts are to be made in the case of sudden, unexpected cardiac or respiratory arrest. Before writing a DNR order, the physician will confer with the patient, his or her agent, or family, in order to discuss the patient's wishes, condition and prognosis.
For people living in the community (including nursing facilities) who have decided upon Do Not Resuscitate (DNR) status, the Comfort Care/DNR (CC/DNR) protocol was developed by the Massachusetts Department of Public Health, Office of Emergency Medical Services. The existence of the Comfort Care/DNR form in the home (or nursing facility) will enable EMT's and first responders to honor a patient's request for no resuscitation and to provide the patient with palliative care in conformance with the Comfort Care protocol. The Comfort Care/DNR form must be signed by the patient, health care proxy, or guardian and an attending physician, authorized nurse practitioner or authorized physician assistant. When a patient who has a Comfort Care/DNR form in place and is admitted to the hospital, the physician will verify with the patient (or health care proxy) that he/she still requests DNR status and if so, will write the DNR order in the patient's medical record.
In addition, The Massachusetts Medical Orders for Life Sustaining Treatment (MOLST) is another form issued by the Massachusetts Department of Public Health, which patients and their health care providers can use to document the results of discussions they have had regarding appropriate life-sustaining treatment. Massachusetts is currently transitioning to use of the MOLST form. At this time, patients may have either form, and as long as the form is current and valid, it will be honored.
The Right to Information about Proposed Treatments
You (or your agent or representative) has the right to receive from your doctor, the information that you need in order to make informed decisions about whether to agree to a procedure or treatment that your doctor recommends.
This information should generally include:
- A description of the recommended treatment or procedure, and its risks and benefits;
- A description of the risks and benefits of alternative treatments or procedures (if there are any), including the likely result of having no treatment at all;
- Any other information you may want, which the doctor is able to provide.
It is very important to remember that although physicians cannot guarantee the results of a medical treatment, you have the right to ask, and you should ask your doctor, any questions you may have about your condition, or about any proposed treatments or procedures.
There may come a time when, because of an illness or accident, you are not able to communicate your wishes regarding your medical treatment. The purpose of the advance directive is to provide written instructions about your wishes for medical treatment when you become unable to make health care decisions. Types of advance directives include a Health Care Proxy, a Living Will, and a Durable Power of Attorney and a MOLST form. These documents tell health care providers who you assign to speak for you as your health care agent. Your health care agent may act for you only if your doctor determines that you are unable to make or communicate your health care decisions (for example, if you are in a coma). Your health care agent would then have the legal authority to make all health care decisions for you, including decisions about life-sustaining treatment unless you place limitations on your agent's authority in the Health Care Proxy form.
Health Care Proxy
There may come a time when, because of an illness or accident, you are not able to make your own decisions. The purpose of the Health Care Proxy is to make sure that your wishes are respected if you become unable to make health care decisions.
You are not required to complete an advance directive such as a Health Care Proxy form in order to receive medical care. You have the right to receive the same type and quality of health care whether or not you complete a Health Care Proxy.
Upon your admission to the hospital, you will be asked whether you have completed a Proxy. If you have completed a Health Care Proxy, you should give a copy to your doctor, nurse or social worker to put in your medical record. You should also notify your Health Care Agent if you know that you are going to be in the hospital. If you have not completed a Proxy, one will be provided to you, along with relevant information, to help you complete the form.
Even if you have not selected a Health Care Proxy, you can still write down specific instructions about how you wish to be treated if you become terminally ill and/or unable to make decisions. This is sometimes called a "Living Will." Although Living Wills are not recognized as legally binding by statute in Massachusetts, these instructions can help other people know of your wishes regarding future medical treatments. You can also speak to your physician while in the hospital and he can complete the MOLST form documenting your wishes for medical treatment.
Health Care Proxy forms and additional information are available in the Patient Access and Case Management departments, and on the nursing units. If you need assistance to complete the Health Care Proxy form a social worker can assist you, please call the case management department at 781-453-5414 for assistance.