It is normal to feel uncertain and perhaps frightened when faced with a major illness. You should know as much about your medical care as you can. This means asking questions. Your physician should be the primary source for medical information. Since you will be making many of the decisions together, ask your physician to explain what you do not understand. You may also ask the nurses, medical social workers, therapists and other members of the health care team involved in your care.
If difficulties occur in making decisions, Kuakini has an Ethics Committee that is available to patients, family members and staff. This is a multidisciplinary committee that serves as a resource and advisor for ethical issues. Ask your physician or any member of your health care team if you want more information about this committee.
"Informed Consent" means that you have been given information about your illness and you understand and agree to a procedure and/or treatment that is planned for you. Before a medical treatment procedure begins, you should know the answers to the following questions:
- Why is this procedure/treatment necessary now?
- What are the risks involved?
- What are the goals of the treatment/procedure?
- Are there any other reasonable alternatives?
- If you don't know the answers to these questions, ask your doctor.
Artificial Life Support
Unfortunately, there are situations in the course of a serious illness that may require you, or your family, to make a decision about "artificial life support systems." People tend to think of these as "machines that keep you alive," such as a ventilator that breathes for you when you are unable to breathe on your own. However, an artificial life support system can be something as simple as an intravenous (I.V.) or a feeding tube that provides fluid and nourishment to you. Many of us have heard about "people being kept alive on machines" and have decided that we want no part of that. However, "artificial life support systems" are used often to help people during an illness. Ventilators, for example, are frequently used after surgery to support the patients' breathing until they wake up and are able to breathe on their own.
When it is clear to everyone that there is no hope for recovery, many people would prefer not to be placed on, or kept on, artificial life support systems. Some may want everything to be done. There is no right or wrong choice. Deciding against artificial life support does not mean that all medical care stops. The main concern is to provide quality medical care to maintain patient comfort and dignity.
Decisions about artificial life support measures require much time and thought. Many questions may arise. It may be difficult to make decisions when one feels pressured and rushed. Ideally, everyone should discuss and make decisions about these vital issues before they occur.
A "Code Blue" (or "Code" or "CPR" - cardiopulmonary resuscitation) is a set of emergency procedures to help a person whose heart and/or lungs have stopped suddenly. It may include external chest compression (i.e. pushing down on the chest) to provide artificial circulation, electric shock to stimulate the heart, a tube inserted into the windpipe attached to a machine to breathe for the person or special medication and transfer to an intensive care unit. There are situations when these procedures may not be appropriate. For example, a terminally ill patient and family members may not want these procedures done which may prolong the dying process and detract from the patient's dignity and quality of life.
Unless you and your physician decide otherwise, a Code Blue procedure will be carried out. Therefore, you need to relay your thoughts and wishes on this matter to your family and physician.
Kuakini recognizes that patients have the right to make decisions regarding their medical care; including the right to accept or refuse medical or surgical treatment and the right to make their choices known through Advance Directives.
Advance directives are a patient's oral instructions and statements or written documents, such as individual instructions (formerly known as the living will) or durable power of attorney for healthcare. Advance directives are provided by the patient in advance of losing decision-making capacity; and state the patient's choice about medical treatment or names someone to make such choices if the patient becomes unable to make decisions.
If you have an advance directive, Kuakini will honor your request in compliance with Hawaii State law. Hawaii Revised Statutes 327E, permits a competent adult (age 18 or over) to make a written declaration in advance, instructing his/her physician to provide, withhold, or withdraw life-sustaining procedures under certain conditions such as a terminal condition or a permanent loss of the ability to communicate with others. The law allows a person to choose to have all available treatment in order to stay alive as long as possible or to refuse some or all treatment.
Once you are determined to have lost your decision-making capability, your physician must follow the terms of your advance directive. If your physician is not willing to comply with your advance directive, he/she must transfer your care to another physician without unreasonable delay.
Kuakini requests that you bring a copy of your advance directive when you are admitted so we can file it in your medical record for future reference. Kuakini will provide the necessary care to all patients regardless of whether or not an advance directive has been executed.
If you do not have an advance directive and would like more information on this or would like to make an advance directive, contact the Admissions Department at 547-9789 or at in-house extension 8789 or the Medical Social Work Department at 547-9189 or in-house extension 8189.
Informational handouts, sample documents, and assistance in making appointments with a notary public are available in these offices.
Making a Decision for a Loved One
If you must make a decision for a loved one, the decision should express the patient's own personal ideas or feelings regarding artificial life support. The law provides for the designation of a surrogate decision-maker in certain circumstances when there is no written advance directive on record from the patient. The nurse, medical social worker, chaplain, or physician can provide you with information and support in making the appropriate arrangements and decision. A decision may be changed at any time, either orally or in writing.
Some individuals may wish to donate organs or tissue at the time of death. Make your wishes known to your family and physician. Brochures on organ transplants are available in the Admissions Department or call 547-9789 or in-house extension 8789.