law recognizes that all persons have the right to control the decisions
that relate to their own medical care. This control includes those
decisions which an individual can make to have "life-sustaining"
procedures maintained, withheld or withdrawn in the event the person is
diagnosed as having a terminal and irreversible condition. In Louisiana
the way an individual makes such decisions and communicates the
decisions to others is called a "Declaration."
adult--i.e. each competent person eighteen (18) years of age or
older--has the right to make a Declaration. A Declaration is a written,
oral or non-verbal communication which expresses the person's wishes
regarding the maintaining, withholding or withdrawing of
life-sustaining procedures in the event the person is diagnosed as
having a terminal and irreversible condition. In other words, you can
make a Declaration and instruct your physician and your friends and
family to maintain life-sustaining procedures and thereby maintain your
life, or you can instruct them to withhold or withdraw such procedures
and allow you to die.
You may also use a Declaration to
designate another individual to make treatment decisions on your behalf
in the event you are unable to do so. Because you may not be able to
communicate your desires in the event you have a terminal and
irreversible condition, the law allows you to make your Declaration
before such unfortunate circumstances exist.
Although it could
include many things, basically a life-sustaining procedure is the kind
of procedure (including the giving of food and water), which would only
prolong the dying process. Such procedures do not include any measure
which is necessary to provide comfort. A "terminal and irreversible
condition" means what it sounds like and includes:
- A continual profound comatose state with no reasonable chance of recovery.
condition because of injury, disease, or illness which will result in
death and for which life-sustaining procedures would only postpone
You should know that if you fail, for any reason,
to make a Declaration, the law will not presume that you desire that
life-sustaining procedures be maintained. In fact, the law allows
certain other people to make a Declaration for you if you are diagnosed
as having a terminal and irreversible condition, unable to act on your
own behalf and have not made a Declaration. Such a Declaration could
authorize the withholding or withdrawing of life-sustaining procedures.
Sometimes a Declaration is referred to as a "Living Will."
Louisiana law provides a suggested form, but it is only
that--suggested. You are free to use your own words and you can make
your instructions as specific as you desire. The form is not as
important as the content of your Declaration--that is, the law is more
concerned with your desires and instructions than with the form of the
Your Declaration may be written or it may be
made through any non-verbal communication. However you choose to make
your Declaration, you must make it in the presence of two (2)
witnesses. Any adult person may act as a witness as long as that person
is not related to you by blood or marriage AND as long as that person
is not entitled to inherit any portion of your estate.
you make a Declaration, you must notify your physician. It is your
responsibility to take care of giving this information to your
physician. In addition, you may register your Declaration with the
Office of the Secretary of State. However, you are not obligated to do
this. To register your Declaration you should send either a certified
copy or the original Declaration itself to:
Office of the Secretary of State
PO Box 94125
Baton Rouge, LA 70804-9125
The office now charges $20 for registration. If you have any questions, you may call the office, (504) 342-4980.
You may revoke a Declaration at any time. To revoke a Declaration you may:
- cancel, deface or destroy the Declaration
- in writing, express your desire to revoke
- through verbal or non-verbal communication, express your desire to revoke
a written notice of revocation with the Secretary of State, in the
event you registered your Declaration (currently this fee is $5).
Health Care Power of Attorney
form of Advance Directive recognized by Louisiana is the Health Care
Power of Attorney. You may use this to appoint someone to make health
care decisions on your behalf, but you must expressly state this is
your wish and intent.
Memorial Medical Center
the policy of Memorial Medical Center that competent adult patients
have the right to make decisions concerning their medical care,
including the right to accept or refuse treatment and the right to
formulate Advance Directives. However, patients are not required to
have an Advance Directive in order to receive care or treatment at
It is Memorial's policy that when a decision is made,
pursuant to a Living Will/Declaration to forgo life-sustaining
procedures, the dignity of the individual is to be preserved and
measures to foster the patient's comfort, including nursing care,
personal hygiene and analgesics, will be maintained.
Sample Living Will/Declaration and Health Care Power of Attorney forms are below. For more assistance, call Pastoral Care at (504)897-5961, Baptist Campus, or (504)483-5248, Mercy Campus, or Social Services, (504)897-1423, Baptist Campus, or (504)483-5150, Mercy Campus.
adult patients have the right to make decisions concerning medical
care, including the right to accept or refuse treatment and the right
to formulate Advance Directives (Living Will/Declarations and
Healthcare Power of Attorney). The hospital will honor and comply with
the terms of Advance Directives presented to the hospital.
are not required to execute Advance Directives in order to receive care
or treatment. When a decision is made pursuant to a Living
Will/Declaration to forgo life-sustaining procedures, the dignity of
the individual is to be preserved and measures to foster the patient's
comfort, including nursing care, personal hygiene, and analgesics, as
ordered by the patient's physician, will be maintained.
Living Will/Declaration Form
Fill in the blanks and check all life-sustaining procedures that you
choose to have withheld or withdrawn under the circumstances set forth
in the Living Will.
- 2. Sign original Living Will in the
presence of two (2) witnesses who are not related to you by blood or
marriage and who are not going to inherit from you.
- 3. Give one copy of your Living Will to your physician.
Give one copy of your Living Will to a friend or relative who can be
trusted to produce the Living Will in the event that you are certified
by two (2) physicians to be suffering from a terminal and irreversible
condition or to be in a continual profound comatose state with no
reasonable chance of recovery and that the application of
life-sustaining procedures would serve only to prolong artificially the
State of Louisiana
Parish of ________
Declaration made _________ this day of ___________________
___________________, being of sound mind, willfully and voluntarily
hereby make known my express wish and directive that my dying shall not
be artificially prolonged under the circumstances set forth below and
do hereby declare that if, at any time, I should have an incurable
injury, disease, or illness and be certified by two (2) physicians (one
of whom shall be my attending physician) who have personally examined
me and determined that I am suffering from a terminal and irreversible
condition, or to be in a continual profound comatose state with no
reasonable chance of recovery, and the said physicians determine that
the application of life-sustaining procedures would serve only to
prolong artificially the dying process, I direct that, except to the
extent necessary to give full effect to the provisions of any valid
document executed by me providing for the donation of any of my
organ(s), such life-sustaining procedures be withheld or withdrawn and
that I be permitted to die naturally with only the administration of
medication or the performance of any medical procedures deemed
necessary to provide me with comfort care.
The life-sustaining procedures I choose to have withheld or withdrawn include but are not limited to:
(check all that apply)
- __heart-lung resuscitation (CPR)
- __mechanical ventilator (respirator)
- __tube feedings (food and water delivered through a tube)
- __intravenous feedings (nutrition or fluids through an IV tube)
- __ other _________________
the absence of my ability to give directions regarding the use of such
life-sustaining procedures, it is my intention that this declaration be
honored by my family and physician(s) as the final expression of my
legal right to refuse medical or surgical treatment and accept the
consequences from such refusal.
I understand the full import of this declaration and I am emotionally and mentally competent to make this declaration.
declaration is made and signed by me in the presence of the undersigned
witnesses who are not related to me by blood or marriage and who do not
stand to inherit from me.
Signature of Declarant
The declarant is known to me and I believe the declarant to be of sound mind.
Power of Attorney For Healthcare Decisions
Fill in all blanks including home address and telephone number of those
whom you are authorizing to make healthcare decisions for you.
- 2. Sign in the presence of two (2) witnesses.
- 3. Give to the person named in your document.
State of Louisiana
Parish of ________________
_________________, being of sound mind do hereby designate
(name)__________________ of (address, city, state zip)
(telephone) ___________________ to serve as my attorney-in-fact with
full authority to healthcare and treatment decisions for me, including
decisions concerning surgery, medical expenses, hospitalization,
selection of physicians, nursing home residency and medications, in the
event that I am determined by my physician to be physically or mentally
incapable of making such decisions.
Such attorney has full
authority to make such decisions as fully, completely and effectually,
and to all intents and purposes with the same validity as if such
decisions had been personally made by me. It is my understanding and
intention that decisions concerning the withholding or withdrawal of
life-sustaining procedures are not governed by the Power of Attorney
but may be governed by a duly executed Living Will/Declaration.
This done and signed this __________day of _________, ___________
Signature of Declarant
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