House Staff Manual - Winthrop University Hospital

Signature of two witnesses, neither of whom is the named proxy or physician, date and statement bywitnesses that the patient (principal) appeared to execute the proxy willingly.The patient may choose to specify his/her wishes with regards to specific treatments. The completed formor a copy of the form is to be placed in the patient's medical record, under the tab, Advance Directives; theproxy remains in effect indefinitely unless it is revoked or contains an expiration date. The form does notneed to be reissued in the event of any future admissions.Any questions regarding Health Care Proxies should be referred to Risk Management and InsuranceServices (ext. 2206) or Patient Relations (ext. 2058).AGENT IN HEALTH CARE DECISIONSThe agent may make health care decisions during the time when the patient lacks capacity to make thesedecisions.The determination of lack of capacity may be made by the attending physician except when lack ofcapacity is due to primary mental illness (which must be confirmed by a board-certified psychiatrist). Thedetermination of lack of capacity is to be documented in the medical record and is to include the cause,nature, extent and probable duration of the incapacity. The patient must be given oral and written notice ofthe determination if he/she is capable of understanding. If the patient objects to the determination or to theagent's decision, the patient's objection prevails unless a court determines that the patient lacks capacity. Iftreatment is life-sustaining, lack of capacity must be confirmed by another physician.The consent of the agent is necessary for the issuance of a DNR order and the appropriate DNRforms should be completed.The agent may make any health care decisions on the patient’s behalf except those involving nutrition orhydration, which may not be discontinued unless there is "reasonable knowledge" of the patient's wishes.Unless otherwise limited, the agent's authority takes priority over any other decision-maker, including nextof-kin.In accordance with hospital policy, the agent has access to all medical information and medical recordsnormally available to the patient.Prior to the commencement of action or inaction under the health care proxy, the Director of RiskManagement or Administrator-On-Call must be notified to determine the scope and/or limitations of theagent's authority in conjunction with the physician.The appointment is not valid for decisions after death (autopsy, organ donation); at that point authorityreverts to next-of-kin.REVOCATION OF PROXYThe proxy can be revoked at any time, either orally or in writing. A staff member who is informed of apatient's wish to revoke/change agent shall immediately notify the physician in charge of the patient's care,sign and date the proxy form, and note the revocation of the proxy. The physician shall note the revocationin the medical record and shall inform the agent and the medical staff involved in the patient's care.DISPUTE REGARDING AGENT AUTHORITYAny questions or disputes over the agent's authority to make decisions should be referred to the RiskManagement and Insurance Services (days) or Administrator On-Call (evenings/weekends).LIVING WILLSRev. 1/08