How to Fill Out Oregon's Advance Directive
How to Fill Out Oregon’s Advance Directive
By Patricia L. Nelson
In September of 2021, the State of Oregon implemented a new Advance Directive form. This new form is quite different from previous Advance Directive forms here in Oregon. Page one of the new form is instructions. The document is broken into sections by number and subsections by letters. Section 1 on page 2 is where you list your name and all of your contact information. Section 2, which is also on page 2, is where you provide the names and full contact information for your Healthcare Representative and all alternates.
Section 3, starting on page 3 is where the 2021 form begins to be different from earlier forms. Subsection A, on pages 3 and 4, discusses three conditions in which you could find yourself. The first one is Terminal Condition. It requires that you have an illness that cannot be cured or reversed, and your health care providers believe it will result in your death within six months.
The second condition is Advanced Progressive Illness, which requires that you have an illness that is in an advanced stage, that your health care providers believe it will not improve and is very likely to get worse over time and result in death, and your health care providers believe that you will never be able to (1) communicate, (2) swallow food and water safely, (3) care for yourself, and (4) recognize your family and other people. If you meet all of those requirements, you are considered to have an Advanced Progressive Illness under the Advance Directive.
The third condition is Permanently Unconscious. To be Permanently Unconscious, you must not be conscious and your health care providers must believe it is very unlikely that you will ever become conscious again.
In each of these three conditions, the 2021 Oregon Advance Directive form gives you four choices. The four choices are the same for each of the three conditions. The first choice is that you want to try all available treatments to sustain your life, including artificial feeding and hydration with feeding tubes, IV fluids, kidney dialysis, and breathing machines. The second choice is that you want to try to sustain your life only with artificial feeding and hydration with feeding tubes and IV fluids but not other treatments. The third choice is that you do not want any life sustaining treatment; that you want to be kept comfortable and be allowed to die naturally. And the fourth choice is that you want your Healthcare Representative to make the decision for you.
Part B of the form goes on to allow you to include specific instructions about the kind of care you want and do not want. So, for example, if you select the third option, the one for no life support, but you really do not want to be thirsty, you could indicate that you would like to be given fluids for comfort. Some examples of what our clients have said in this section are:
· I do not want to be thirsty or in pain. Make me comfortable and hydrated. Do not prolong my life if there is no hope for future joy. Quality of life, not length of life, is what is important to me
· I want to preserve my dignity and be allowed to die naturally. I do not want to prolong my life with the assistance of artificial life-sustaining treatments!
If you select choice 1, 2, or 3, you can consider your Advance Directive to be complete. If, however, you select choice 4, then you may need to complete Part B. In Part B, which starts on page 5, you are asked to provide information for your Healthcare Representative about what is important to you about your life. Some examples of answers our clients have provided are:
· I want to be able to enjoy life. It is okay if my world gets smaller as long as joy and enjoyment are present. If that’s not possible, then it’s time for the next adventure.
· It is very important that I be allowed to die peacefully with dignity. If I have prayers, I’m pleased and shall die in peace.
Section 3, Part B also gives you an opportunity to share what you most value about your life. Some examples of responses from our clients are:
· I value family, love, and my spiritual journey with my Lord and Savior Jesus Christ.
· My friends, my husband, my pets, and helping others.
And it invites you to talk about what is most important for you about your life. One sample answer from our clients is:
· My life has been amazing, so I want to be allowed to die gracefully, with dignity in peace, as I transition from this earth. My life was better than I could have hoped. I loved, lived, laughed, cried, fell down and got up all by the grace of God! It’s time for me to leave the party! A lady always knows!
Section 3, Part B goes on the list several activities that you may initial to indicate that you do not want life-sustaining procedures if you cannot do them. Those activities are to express you needs; be free from long-term severe pain and suffering; know who you are and who you are with; live without being hooked up to mechanical life support; and to participate in activities such as, at which point there is a space for you to write in the list of activities.
The form then invites you to share with your Healthcare Representative about what matters most to you in making this decision. Some examples from our clients of responses to this prompt are:
· I love that I live in a right to die state. If joy is hopeless, I am done. I see death as a new adventure.
· Remember, my death is about leaving this earthly existence to be with my Lord and Savior in Jesus Christ! My life has been good, I want to leave in peace!
Part 4, Section C on page 6 gives you an opportunity to share about your spiritual beliefs. It is optional. Obviously, for some this provision will be very important. For others, it might be best to leave this part blank. Some examples of responses from our clients are:
· I am spiritual but very anti-organized religion. I believe my soul is enteral and I will return to form instead of energy when I need to learn embodied lessons. I am pretty sure I’m not done.
· As a Christian, the death of my body in this life is not the end, for I’m a child of God. To be removed from my earthly body is to be with the Lord!
· If available, I would want a Catholic priest to administer the Last Rites and Anointing of the Sick, Confession, and final Holy Communion. Only Anointing of the Sick, if unconscious.
Part 4, on page 7, allows you to provide more information. Section A lets you discuss your Life and Values. Some answers from our clients include:
· I love the Lord, he has shown me much favor and grace! Death does not cause me fear! My life has been good. I’ve loved a lot and been loved beyond measure! I believe in the resurrection of the body’s life everlasting.
· When my dad was 90, he had to go to the nursing home and he only lived about 6 weeks. He stopped taking medication and eating because he was ready to move on. He couldn’t hear or see much and had severe arthritis. I pray that I will have the same strength and foresight to know when there is no more joy in my life.
Part 4, Section B allows you to specify your Place of Care. Some responses from our clients included:
· If I am at maximum recovery and have ongoing needs, I do not want to be in an institution. I would rather have care at home, if possible.
· If I am transitioning, I’d like to be placed in Hospice House (Partners in Care) in Bend, OR. If short- or long-term care is needed, then in Aspen Ridge in Bend, OR. I do not want my family as care providers to be burdened with my life ending care on a daily basis.
And Part 4, Section C allows you to specify other instructions you may want to add. In this section, my firm offers you the option to adopt the “Dementia Provision.”
We add the Dementia Provision as the last page of the document. This provision expands the scope of the Advance Directive to include situations in which you are not about to die. In fact, you could live a very long time with artificial food and hydration. But you have advanced dementia. You are conscious but you are consistently and permanently unable to communicate, swallow food and water safely, care for yourself and recognize your family and other people, and it is very unlikely that your condition will substantially improve. In this situation, the Dementia Provision allows you to specify whether you want to be fed and whether you want to be given fluids.
Part 4, Section D, allows you provide the names and contact information of people with whom you want your health care provider (e.g. doctor) to be able to discuss your health information.
Part 5 is where you sign this document. In Part 6, your signature must be witnessed by two witnesses who are not your Healthcare Representatives. Alternatively, you may sign it in front of a notary public.
Your Healthcare Representatives can sign Part 7 on page 10 to accept their appointment as your Healthcare Representatives. At least your primary Healthcare Representative needs to sign this page as soon as possible.
