Medical Staff House Staff Orientation Manual - Montefiore Medical ...

MMC must permit an individual the right to request restrictions relating to uses or disclosures of
PHI about the individual to carry out treatment, payment or health care operations. When
possible, the request should be submitted in writing.
MMC will accommodate reasonable requests from individuals to receive communications of PHI
by alternative means or alternative locations. Requests should be submitted in writing.
CONTACT
Privacy Officer 718-920-4728
ADVANCED DIRECTIVES- HEALTH CAR PROXIES AND LIVING WILLS
Administrative Policy and Procedure JH41.1
Note: This summary contains the key points of this policy. For a complete understanding of all
the relevant provisions, it is necessary to thoroughly read the full policy.
WHAT:
Advance directives are written or oral health care wishes expressed by a person with decisional
capacity. Providers are legally and ethically bound to refer to advance directives when decisions
must be made for patients without the capacity to make them. Advance directives take two
forms:
• Health care proxy is a person’s legal appointment of another individual (health care agent) to
make health care decisions on the person’s behalf in the event of subsequent incapacity.
• Living will is a list of instructions about interventions the person would consent to or refuse
under specified circumstances.
WHO:
• All patients over 18 years of age, regardless of health status, should be encouraged to appoint
a health care agent.
• Any person 18 years or older may appoint a health care proxy, create a living will and/or be a
health care agent.
• A health care agent is specifically chosen and legally appointed by a capacitated person.
Family, even next-of-kin, may not automatically make many important decisions for their
loved ones unless they are legally appointed health care agents.
• An attending physician makes the clinical determination of decisional incapacity, which
triggers the provisions of an advance directive.
• When a health care agent will make decisions about foregoing life-sustaining treatment, the
determination of patient incapacity must be confirmed by a second attending physician.
WHEN:
Adult patients, even those with advance directives, are presumed able to make their own
decisions unless and until they are clinically determined to lack decisional capacity. Advance
directives take effect only when the patient has temporarily or permanently lost the capacity to
make health care decisions. If and when patients regain capacity, they resume making their own
health care decisions. Advance directives may be created at any time and remain effective until
revoked by the patient or are superseded by new directives from the patient.
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