预先指示, 有时被称为“生前遗嘱”," is a written document that tells your health care providers who should speak for you and what medical decisions they should make if you become unable to speak for yourself. This information is important if you become unconscious or otherwise too sick to make your wishes known.
State and federal laws give you the right to make many health care decisions in advance so that your wishes can be honored in the event you can’t express them. It is your right, 作为有能力的成年人(18岁以上的人), 决定是否接受, 拒绝或停止为自己治疗. 这包括关于维持生命治疗的决定, 比如呼吸机和喂食管.
Documents such as the advance directive can help ensure that your loved ones and your health care team honor your wishes. 尽管这些情况可能会让人觉得不舒服, planning in advance offers you and your family members peace of mind and helps eliminate confusion in a difficult time.
预先指示 is a legal document that shares your wishes for care at the end of your life. Paulette shares the story of her brother's life and the importance of establishing an advance directive.
预先指示有几个部分, which allow specific health care directions to be given or to appoint others to make decisions if needed. These include:
A living will is a written document that specifies what medical treatment you would or would not want in the event you are in a terminal condition or a persistent vegetative state. A living will directs health care providers to cease or refrain from certain medical/surgical treatments.
绝症是指无法治愈的疾病, 由于受伤而导致的不可逆转的晚期医学状况, 疾病或身体疾病, which will, 根据主治医生的意见, 在医学上有一定的确定性, 无论继续使用维持生命的治疗，都会导致死亡.
Power of Attorney
A durable power of attorney for health care decisions is a document by which you can designate, in writing, another person (an agent) who will be able to make health care decisions on your behalf if you are unable to do so yourself. You may specify whether the appointment of an agent takes effect immediately or at the time you are unable to make your own decisions.
The appointed health care agent has broader power to execute your wishes than can be provided under a living will, so you will want to select your agent carefully to make sure your agent knows and will follow your wishes. 不像生前遗嘱, 委托书并不一定要处于临终状态才能生效.
Health care instructions are another form of written advance directive that can be used alone or together with the appointment of a health care agent. Health care instructions allow you to specify what treatment you want or do not want in the event you are in a terminal condition, 持续性植物人状态或终末期状态, 并表达其他医疗保健决定, 比如不抢救(DNR)指令, 器官和组织捐赠以及透析的特殊说明, 还有输血.
Talk with your physician and your family or others close to you about your feelings regarding medical treatment and health care. 如果你在医院, 你可以问你的护士是否有一个训练有素的医院代表, 比如牧师或社会工作者, 与您谈谈预先指示，并提供必要的表格.
你不需要请律师来获得预先指示, 但如果你有法律上的顾虑或问题, 你应该咨询医生. 请注意，关于预先指示的法律在每个州是不同的.
There are sample forms available online from various organizations you can use to get started with your advance directive (约翰霍普金斯大学不对这些表格的内容负责):
No, you do not. However, an advance directive is a good way to make your wishes regarding your medical treatment known, to reduce confusion among your family and your caregivers and to have your wishes honored.
There are two types of advance directives: those that are written in a document and those that are spoken in the presence of a witness.
你可以在证人在场的情况下向你的医生作口头陈述, 提供指示或指定保健代理人. This statement regarding your wishes must be recorded in your medical record by your physician and signed and dated by the physician and witness.
Different states may have different restrictions on who you can name as your health care agent. Generally, 你的代理人可以是任何有能力的成年人，而不是雇员, 您接受治疗的医疗机构的所有者或经营者, 虽然如果这个人是你的亲戚，可能会有例外.
Legally, 您可以指定多个医疗保健代理, 但建议只有一名代理人获得持久授权书. You can also name an alternate agent who would take on the responsibilities of your primary agent if he or she resigns or is otherwise unable to fulfill their duties.
- If a disagreement arises between equal ranking decision-makers regarding your medical treatment, 你的医生可以咨询医院的澳门网上正规网站护理咨询委员会.
- If your physician believes that an instruction to withhold or withdraw life-sustaining procedures from you is inconsistent with generally accepted standards of patient care, the physician may consult the hospital's Patient Care Advisory Committee or file a petition in court.
- A physician doesn’t have to provide treatment he or she believes to be medically ineffective or ethically inappropriate. In cases when such treatment is requested by a patient or those making decisions on the patient’s behalf, 医生必须提供一个选择，要求转移到另一个医生和, if desired, 协助接送. 等待转让, the physician must comply with the request for treatment if failure to comply would result in the death of a patient.
一旦你完成了预先指示, tell your health care provider and close family or friends about your decisions and give them a copy.