Advance Directives

As a courtesy service, Boone Hospital Center's chaplains and social workers offer education regarding advance directives (such as Living Wills, Durable Power of Attorney for Health Care, and Health Care Directive). Our staff will explain the use of these documents, how they differ, and answer questions. Anyone may request this service - you need not be a patient or family member. Advance directive booklets are free of charge to the public.

Upon request by an individual, Boone Hospital Center will keep a copy of advance directives in the patient record of anyone who has a medical record at Boone. For a copy, please contact us at 573.815.3888.

• Life Planning Worksheet
• Durable Power of Attorney for Healthcare Choices
  • This is a document that allows you to choose an agent to make your medical choices, end-of-life choices, and speak on your behalf.
• Healthcare Choices Directive
  • This is a document whereby you are able to communicate your end-of-life medical choices, and it speaks on your behalf.

Read our “what if” narrative, depicting an elderly couple and their son dealing with a difficult but necessary end-of-life decision:

To Call 911... or Not to Call 911?

Carlos had been caring for his wife, Hazel, since she was discharged from the hospital on palliative care. Their son, Will, arrived on Saturday; together, the two men spent the morning at Hazel’s bedside. Around lunchtime, Carlos went to the kitchen to quickly fix a couple of sandwiches. Just as he finished, Will called out from the bedroom. Carlos hurried back to find that although Hazel was still breathing, she was unresponsive.

“I panicked,” Will admits. “I wanted Dad to let me call 911; that’s what you do when someone loses consciousness at home, right?”

“We both felt scared and helpless,” agrees Carlos, even though he’d been preparing for Hazel’s passing. “But I knew Hazel wanted to die at home with the people she loved by her side. She wouldn't want an ambulance taking her back to the hospital, where she’d be surrounded by machines keeping her alive.”

Fortunately, part of Hazel’s discharge planning several days before had involved a discussion with the hospital’s palliative care nurse, Nancy. “I didn't want to talk about it, and it wasn’t easy, but now I’m glad we did.” Carlos says. Rather than wait until a highly emotional and distressing time to make decisions, Nancy supported the couple in identifying their wishes; and then she explained how to accomplish those wishes in terms of what to do and who to call. Nancy’s discussion with Hazel and Carlos about “dying with dignity” included:

• Where would you like to be as you are dying?
• Who would you like to be with you?
• What medical treatment or comfort measures do you prefer?
• What can care providers expect as the dying process occurs, and how can they best meet the dying person’s wishes?
• Are the care providers capable and willing to meet the dying person's needs?

Carlos was especially concerned that Hazel would die before his son arrived; he had never been alone with somebody who was dying before. Nancy explained that in addition to calling upon any personal resources Carlos might have (other family, friends, faith community), there were also community resources available:

• Home health or hospice personnel, in addition to home visits to the patient, provide support and guidance based on the wishes of the patient and care providers.
• If the patient appears uncomfortable, emergency personnel (accessed by calling 911) can provide comfort treatment without resuscitation.
• Once the patient dies, care providers can call the medical examiner. Care providers who don’t know how to contact the medical examiner can call the police, non-emergently, and they will help contact the medical examiner.

Instead of dialing 911, Carlos chose to call his wife’s home health nurse, who offered to come to the house to be sure that Hazel was comfortable. The nurse stayed until Hazel peacefully passed away about an hour later, then she called the county medical examiner. She then helped Carlos make the call to the funeral home he had chosen.

Calling 911 is still the best response when someone collapses unexpectedly or without explanation. But for patients and their care providers who are awaiting the end of life, it’s good to know there are other options that honor their wishes. As healthcare providers, we have the opportunity to explain these options. As Carlos puts it: “Thanks to our nurse’s willingness to help us plan ahead, I knew what to expect and how to handle it.”

Will adds, “We wanted to do everything we could for Mom. But in the end, the best thing we could do for her was to do what she asked: to let her leave this life naturally, in comfort and peace, with Dad and me keeping her company.”

- Theresa McDonald