QR code is linked to Appointing someone to make decisions on behalf of you
During challenging situations, such as accidents or serious illnesses, you or your loved ones may need to make healthcare decisions. It is advantageous to have contemplated your decision-making preferences and identified individuals you want involved in those choices beforehand.
Expressing and documenting your preferences for how you wish to live, including the location and specific procedures you are open to, is crucial. Although addressing this section may be challenging, it is advisable to make these decisions with a clear mind and without time constraints.
Your healthcare team is obligated to adhere to these directives, providing a pre-established framework for the specific treatments you do or do not wish to receive. This document is a guide for your loved ones and maybe you would like to put in writing who you would like to speak for you. This can help the health professionals when asking for someone else to make a decision. It can provide peace between your loved ones and eliminate any opposing opinions.
I would like:
□ All appropriate treatment to keep me alive
□ Only to receive treatment if the doctors expect that I will recover to my previously quality of life and is medically appropriate
□ Only treatment that provide comfort, symptom management, pain relief and dignity
□ No treatment where all/any of following conditions occur-
- Unable to recognise family and loved ones
- Unable to eat or drink except through a stomach tube or intravenous drip
- Loss of bladder and bowel control
- Continuous administration of drugs to continue or prolong life
□ My EG/ Substitute decision maker to make this choice
□ The medical professionals to decide
□ I have no preference and I am undecided
Cardiopulmonary Resuscitation (CPR)
- If your heart stops beating or does not beat enough to pump blood around your body- this treatment helps- it is done by a person compressing your chest
- A machine that assists you to breath
- A feeding tube through the nose or the stomach
- Fluid given via a tube into a vein, tissue or stomach
- A transfer of blood including blood products (e.g red cells, platelets and plasma) from one person to another
New procedures or clinical trials
- For example:
- use of artificial valves or organs
- new medications or vaccines
- new surgical devices or procedures
Your choices and types of treatment:
□ Cardiopulmonary Resuscitation (CPR)
□ Assisted Ventilation
□ Artificial nutrition
□ Artificial hydration
□ Blood transfusion
□ Other _________________________________________________________________
□ No treatment
□ I have no preference and I am undecided
Language and Interpretation
□English is my first language- I did not engage an interpreter and/or translator
□English is not my first language- I filled this out with support people
□English is not my first language- I engaged an interpreter to fill out the form
□English is not my first language- I did not engage anyone to help me fill out the form or to make my decision