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Incapacity - Health Care Issues
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Minnesota law recognizes a document called a “Health Care Directive”, which allows you to designate one or more other people to help with a variety of health care decisions by acting as your “health care agent”. The health care directive also allows you to give instructions on a variety of subjects, such as the use of extraordinary means to sustain life, mental health treatment, directions about your funeral, and anatomical gifts. The health care directive is a very adaptable instrument, and addresses the issues covered by “living wills” and durable health care powers of attorney. The health care directive must meet certain basic legal requirements to function successfully.
Minnesota statutes contain the “Patients Bill of Rights”, which must be posted in licensed facilities. The Patients Bill of Rights sets forth a number of protections for residents and patients in care facilities. These protections cannot be waived, for example as a condition of admission to a facility. The law’s intent is that “every patient’s civil and religious liberties, including the right to independent personal decisions and knowledge of available choices, shall not be infringed and that the facility shall encourage and assist in the fullest possible exercise of these rights.” The statute contains a number of provisions, including requirements for provision of information, the right to be treated with courtesy and respect and to have one’s privacy respected, the right to participate in health care planning and to refuse care, the right to freedom from unauthorized physical restraints, and others.
Although many states have prehospital “Do Not Resuscitate Order”, or “DNR” programs, in Minnesota DNR programs exist within individual health care facilities. A “Do Not Resuscitate Order” is generally a medical order not to attempt CPR (cardiopulmonary resuscitation) in the event of cardiac or pulmonary arrest. In states with prehospital DNR programs, the programs generally require a written order signed by a physician in a format that will be quickly recognized by a responder, bracelets or medallions that communicate DNR status to a responder, and provision that comfort treatment not be withheld. According to the University of Minnesota’s Center for Biomedical Ethics, health care professionals should discuss the option of a DNR order with a patient, or the patient’s representative or agent if the patient lacks decision-making capacity, if the patient is terminally ill, if the patient has a severe or irreversible illness or disabling condition, if the patient has suffered an irreversible loss of consciousness, if the patient is reasonably likely to suffer cardiac or respiratory arrest, or if there is reason to question the presumption of the patient’s consent to submit to CPR. The Center for Biomedical Ethics paper is available at
www.bioethics.umn.edu/publications/Resuscitation.pdf.
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