Advance Directives
What is an advance directive?
An advance directive, sometimes called a "living will,是一份书面文件，告诉你的医疗服务提供者谁应该为你说话，如果你无法为自己说话，他们应该做出什么医疗决定. 如果你失去意识或病得太重而无法表达你的愿望，这些信息是很重要的.
州和联邦法律赋予你提前做出许多医疗保健决定的权利，以便在你无法表达意愿的情况下，你的意愿能够得到尊重. It is your right, as a competent adult (a person over the age of 18), to decide whether to accept, reject or discontinue medical treatment for yourself. This includes decisions about life-sustaining treatments, such as breathing machines and feeding tubes.
诸如预先指示之类的文件可以帮助确保您的亲人和您的医疗团队尊重您的愿望. Even though these situations can be uncomfortable to think about, 提前计划可以让你和你的家人安心，并有助于在困难时期消除困惑.
Advance Directives | Your Voice Matters
预先指示是一份法律文件，分享你在生命结束时对护理的愿望. 波莱特分享了她哥哥的生活故事，以及建立预先指示的重要性.
What is included in an advance directive?
An advance directive has several sections, 它们允许给出具体的医疗指导，或者在需要时指定其他人做出决定. These include:
Living Will
生前遗嘱是一份书面文件，它规定了在你处于临终状态或持续植物人状态时，你愿意或不愿意接受何种治疗. 生前遗嘱指示医疗保健提供者停止或避免某些医疗/手术治疗.
A terminal condition is an incurable, irreversible medical condition in an advanced state caused by injury, disease or physical illness, which will, in the opinion of the attending physician, to a reasonable degree of medical certainty, result in death regardless of the continued application of life-sustaining treatment.
Power of Attorney
医疗保健决定的持久授权书是一份你可以指定的文件, in writing, 另一个人(代理人)，如果你不能自己做决定，他将能够代表你做出医疗保健决定. 您可以指定代理人的任命是立即生效还是在您无法做出自己的决定时生效.
与生前遗嘱相比，指定的医疗保健代理人有更大的权力来执行你的愿望, 所以你要仔细选择你的经纪人，以确保你的经纪人知道并会遵循你的意愿. Unlike with a living will, you don’t have to be in a terminal condition for the power of attorney to take effect.
Health Care Instructions
保健指示是另一种形式的书面预先指示，可以单独使用，也可以与指定的保健代理人一起使用. 医疗保健说明允许您指定您想要或不想要的治疗，如果你是在终末期的情况下, persistent vegetative state or end-stage condition, and to express other health care decisions, such as a do not resuscitate (DNR) orders, organ and tissue donation and special instructions for dialysis, and blood transfusions.
How do I make an advance directive?
与你的医生、家人或其他亲近的人谈谈你对医疗和保健的感受. If you are in a hospital, you can ask your nurse about having a trained hospital representative, such as a chaplain or a social worker, speak with you about advance directives and provide the necessary forms.
You don’t have to have a lawyer to get an advance directive, but if you have legal concerns or questions, you should consult one. Please note that laws about advance directives are different in each state.
网上有一些来自不同机构的表格样本，你可以使用它们来开始你的预先指示(Johns Hopkins is not responsible for the contents of these forms):
Frequently Asked Questions
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No, you do not. However, 事先指示是一种很好的方式，让你知道你的医疗愿望, to reduce confusion among your family and your caregivers and to have your wishes honored.
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有两种类型的预先指示:一种是写在文件中，另一种是在证人在场的情况下说出的.
You may make an oral statement to your physician in the presence of a witness, providing instructions or appointing a health care agent. 这份关于您意愿的陈述必须由您的医生记录在您的医疗记录中，并由医生和证人签名并注明日期.
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不同的州可能对你可以指定谁作为你的医疗保健代理有不同的限制. Generally, your agent may be any competent adult other than an employee, owner or operator of the health care facility where you are being treated, although there may be exceptions if this person is related to you.
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Legally, you can designate multiple health care agents, but it is recommended that only one agent receives the durable power of attorney. 你也可以指定一名候补代理人，如果他或她辞职或无法履行职责，他或她将接替你的主要代理人的职责.
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In most cases, there will be no problem in carrying out your wishes. However, there may be some special circumstances, such as:
- 如果同等级别的决策者对你的医疗产生分歧, your physician may consult the hospital's Patient Care Advisory Council.
- 如果你的医生认为停止或撤销维持生命程序的指示不符合一般接受的推荐十大正规网赌平台护理标准, 医生可以咨询医院的推荐十大正规网赌平台护理咨询委员会或向法院提出申诉.
- 医生不必提供他或她认为在医学上无效或在道德上不合适的治疗. 在推荐十大正规网赌平台或代表推荐十大正规网赌平台作出决定的人要求这种治疗的情况下, the physician must offer them an option to request a transfer to another physician and, if desired, assist with the transfer. Pending the transfer, 如果不遵从将导致推荐十大正规网赌平台死亡，医生必须遵从治疗请求.
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Once you've completed an advance directive, 把你的决定告诉你的医疗服务提供者和亲密的家人或朋友，并给他们一份副本.
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The MOLST order form makes your treatment wishes known to health care professionals. It includes the decisions you've made regarding your treatment preferences. This form goes with you to the hospital, rehab, assisted living, and back home. Watch this video to learn more.
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