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When You Can't Decide, Who Will?

Originally Developed by St. Joseph Health System, Tawas City, MI.


What you should know about advance directives, treatment decisions and comfort care.


Planning Ahead

Serious illness can happen at any time. It may shorten your life or leave you unable to make your own decisions. It's important for you to know that you have the right to accept or refuse any medical treatment that is offered. It's also important that you consider appointing a patient advocate. Your patient advocate will carry out your wishes in case you become unable to express your decisions yourself.

As your healthcare provider, we want to make sure that you receive the kind of care and treatment that agrees with your values and beliefs.

No one wants to cause unnecessary emotional or financial distress for their loved ones. That's why a growing number of people are taking action before they become seriously ill. They are putting their healthcare choices in writing while they are still healthy and able to make such decisions. This can be done through a document called an advance directive.

A formal advance directive is a document prepared before a serious illness or personal medical crisis. This document includes your choices and wishes for healthcare and names someone to make those choices if you become unable to speak for yourself. Through an advance directive, such as a Durable Power of Attorney (DPA) for Healthcare, you make legally valid decisions about your future medical treatment.

The Federal Patient Self-Determination Act of 1990 requires health care facilities to inform patients of their right by state law to have advance directives.

Michigan Public Act 312 of 1990 allows Michigan citizens to establish a DPA for medical decisions in the event a citizen becomes unable to make those decisions.

This law authorizes a person you choose (called a patient advocate) to make decisions about your medical care and treatment should you become unable to do so. The person you choose as your patient advocate has a duty to follow your medical wishes. This means, you give them the right to make medical decisions for you if you can't make them yourself. Your patient advocate has the same rights as you do to accept or refuse medical care. Your patient advocate has no power as long as you are mentally capable of making decisions on your own. As you decide what healthcare choices are best for you, it is important to talk about your decisions with your family, your physician and your patient advocate.

St. Joseph Health System has established policies to help you make sound medical-ethical decisions about your treatment. We recognize and respect your right to participate in the course of your treatment based on your physician's medical judgment as well as your ethical and moral values.

Treatment falls into two major groups. One type is called curative care, which is aimed at keeping you alive as long as possible by trying to cure your disease. A second type of treatment is called palliative care, which is aimed at keeping you comfortable. Sometimes, palliative care is given at the same time as curative care. For example, if you have chemotherapy to cure cancer and it makes you nauseous, prescribing medication to ease the nausea would be considered palliative care. Usually, palliative care refers to the type of care where the goal is to keep you comfortable by managing symptoms, rather than to cure the disease.


Common Questions

Where can I receive palliative/comfort care?

Palliative/comfort care is given in many settings (i.e., home, hospital, nursing home) most often when a patient is terminally ill. Hospice programs are designed to care for terminally ill patients. Hospice assists people to achieve the best quality of life possible, by relieving pain and controlling other symptoms associated with their disease. It also provides emotional and spiritual support for the patient and family. Hospice utilizes a team of caregivers (doctors, nurses, aides, therapists, social workers, spiritual counselors, volunteers) to meet the patient's full range of needs.

To be eligible for hospice care, a physician must certify that the patient has a life expectancy of six months or less (if the disease runs its normal course). Hospice also requires that a patient and the family agree to this type of care. Most patients remain at home while enrolled in the program.

If I choose hospice, do I have to change doctors?

No. Hospice programs encourage your personal physician to remain involved in your care. The hospice physician serves as an advisor to your own doctor and to the hospice team. If, at any time, you wish to discontinue your hospice care, or change hospice programs, you have the right to do so.

How do I know when to call hospice?

You can ask your physician or you may call any hospice to learn what hospice can do for you. Through consultation with your physician, it can be determined whether hospice care is appropriate for you.

If I refuse medical treatment, what happens to my insurance?

Michigan law says that, if you refuse life-extending or curative treatment, your life or health insurance company:

  • May not change what they charge you for insurance.
  • May not stop or limit your benefits.
  • May not assume you have canceled your insurance policy.
  • May not prevent your beneficiaries from receiving insurance benefits.

As a Catholic organization, St. Joseph Health System believes that human life, in its body/spirit wholeness, is a God-given gift, which we have a duty to respect, preserve and care for.

We also believe that people have a right and a duty to advance their own higher spiritual and bodily welfare. A person can make a choice about any recommended medical procedure, free from coercion, and based upon a reasonable understanding of the procedure and alternatives.

We believe people have a general moral obligation to preserve their own lives. But when a treatment does not offer a reasonable chance of cure or benefit OR when its burdens exceed its benefits, a person is morally free to refuse treatment.

St. Joseph Health System does not support or participate in acts of "mercy killing" or suicide. We will honor any durable power of attorney for medical care that is within our mission, capacity and applicable regulations and the laws of the state of Michigan.


St. Joseph Health System encourages you to include advance directives in your health care planning.

  • Know your rights.
  • Discuss your wishes with your physician, family and patient advocate.
  • Review your advance directive annually to make sure it expresses your wishes clearly.
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