The Alabama Directive Health Care form is a legal document that allows individuals to express their medical treatment preferences in the event they become unable to communicate their wishes. This form serves as a guide for healthcare providers, family members, and friends, ensuring that a person’s desires regarding life-sustaining treatment are respected. While it is not mandatory to have an advance directive, creating one can provide peace of mind and clarity during difficult times.
The Alabama Directive Health Care form serves as a vital tool for individuals wishing to express their medical treatment preferences in situations where they may be unable to communicate their wishes. This document encompasses two main components: a living will and the appointment of a health care proxy. Within the living will section, individuals can specify their desires regarding life-sustaining treatments and artificially provided nutrition, particularly in the event of terminal illness or permanent unconsciousness. Importantly, individuals can choose whether they want such treatments to be administered or withheld, ensuring that their values and beliefs guide their care. The form also allows for additional personal instructions, enabling individuals to clarify any other specific wishes they may have. Furthermore, the health care proxy section provides an opportunity to designate a trusted person to make medical decisions on their behalf if they become incapacitated. This proxy can be granted varying degrees of authority, from strictly adhering to the documented wishes to making broader decisions based on the individual’s overall preferences. Completing this form not only empowers individuals to take control of their health care decisions but also alleviates the burden on family members during emotionally challenging times.
AD V AN CE D I RECTI V E FOR H EALTH CARE
( Liv in g W ill a n d H e a lt h Ca r e Pr ox y )
This form may be used in the State of Alabama to make your wishes known about what medical treatment or other care you would or would not want if you become too sick to speak for yourself. You are not required to have an advance directive. If you do have an advance directive, be sure that your doctor, family, and friends know you have one and know where it is located.
Se ct ion 1 . Livin g W ill
I, ___________________, being of sound mind and at least 19 years old, would like to make the
following wishes known. I direct that my family, my doctors and health care workers, and all others follow the directions I am writing down. I know that at any time I can change my mind about these directions by tearing up this form and writing a new one. I can also do away with these directions by tearing them up and by telling someone at least 19 years of age of my wishes and asking him or her to write them down.
I understand that these directions will only be used if I am not able to speak for myself.
I f I be com e t e r m in a lly ill or in j u r e d:
Terminally ill or injured is when my doctor and another doctor decide that I have a condition that cannot be cured and that I will likely die in the near future from this condition.
Life sustaining treatment – Life sustaining treatment includes drugs, machines, or medical procedures that would keep me alive but would not cure me. I know that even if I choose not to have life sustaining treatment, I will still get medicines and treatments that ease my pain and keep me comfortable.
Place your initials by either “yes” or “no”:
I want to have life sustaining treatment if I am terminally ill or injured. ____ Yes ____ No
Artificially provided food and hydration (Food and water through a tube or an IV) – I understand that if I am terminally ill or injured I may need to be given food and water through a tube or an IV to keep me alive if I can no longer chew or swallow on my own or with someone helping me.
I want to have food and water provided through a tube or an IV if I am terminally ill or injured.
____ Yes ____ No
I f I Be com e Pe r m a n e n t ly U n con sciou s:
Permanent unconsciousness is when my doctor and another doctor agree that within a reasonable degree of medical certainty I can no longer think, feel anything, knowingly move, or be aware of being alive. They believe this condition will last indefinitely without hope for improvement and have watched me long enough to make that decision. I understand that at least one of these doctors must be qualified to make such a diagnosis.
Life sustaining treatment – Life sustaining treatment includes drugs, machines, or other medical procedures that would keep me alive but would not cure me. I know that even if I choose not to have life sustaining treatment, I will still get medicines and treatments that ease my pain and keep me comfortable.
I want to have life-sustaining treatment if I am permanently unconscious. ____ Yes ____ No
Artificially provided food and hydration (Food and water through a tube or an IV) – I understand that if I become permanently unconscious, I may need to be given food and water through a tube or an IV to keep me alive if I can no longer chew or swallow on my own or with someone helping me.
I want to have food and water provided through a tube or an IV if I am permanently unconscious.
O t h e r D ir e ct ion s: Please list any other things you want done or not done.
In addition to the directions I have listed on this form, I also want the following:
__________________________________________________________________________________
If you do not have other directions, place your initials here:
____ No, I do not have any other directions.
Se ct ion 2 . I f I ne e d som e one t o spe a k for m e .
This form can be used in the State of Alabama to name a person you would like to make medical or other decisions for you if you become too sick to speak for yourself. This person is called a health care proxy. You do not have to name a health care proxy. The directions in this form will be followed even if you do not name a health care proxy.
Place your initials by only one answer:
_____ I do not want to name a health care proxy. (If you check this answer, go to Section 3)
_____ I do want the person listed below to be my health care proxy. I have talked with this person
about my wishes.
First choice for proxy: ________________________________________
Relationship to me: __________________________________________
Address: ____________________________________________________
City: ____________________________ State _______ Zip ___________
Day-time phone number: _______________________________________
Night-time phone number: ______________________________________
If this person is not able, not willing, or not available to be my health care proxy, this is my next
choice:
Second choice for proxy: _______________________________________
Instructions for Proxy
I want my health care proxy to make decisions about whether to give me food and water through a tube or an IV. ____ Yes ____ No
Place your initials by only one of the following:
____
I want my health care proxy to follow only the directions as listed on this form.
_____
I want my health care proxy to follow my directions as listed on this form and to make any
decisions about things I have not covered in the form.
I want my health care proxy to make the final decision, even though it could mean doing
something different from what I have listed on this form.
Se ct ion 3 . Th e t h in gs list e d on t h is for m a r e w h a t I w a n t .
I understand the following:
§If my doctor or hospital does not want to follow the directions I have listed, they must see that I get to a doctor or hospital who will follow my directions.
§If I am pregnant, or if I become pregnant, the choices I have made on this form will not be followed until after the birth of the baby.
§If the time comes for me to stop receiving life sustaining treatment or food and water through a tube or an IV, I direct that my doctor talk about the good and bad points of doing this, along with my wishes, with my health care proxy, if I have one, and with the following people:
____________________________________________________________________
Se ct ion 4 . M y signa t ur e
Your name: _______________________________________________________
The month, day, and year of your birth: _________________________________
Your signature: ____________________________________________________
Date signed: _______________________________________________________
Se ct ion 5 . W it n e sse s ( n e e d t w o w it n e sse s t o sign )
I am witnessing this form because I believe this person to be of sound mind. I did not sign the person’s signature, and I am not the health care proxy. I am not related to the person by blood, adoption, or marriage and not entitled to any part of his or her estate. I am at least 19 years of age and am not directly responsible for paying for his or her medical care.
Name of first witness: ___________________________________
Signature: _____________________________________________
Date: _________________________________________________
Name of second witness: _________________________________
Se ct ion 6 . Sign a t u r e of Pr ox y
I, ____________________________________________, am willing to serve as the health care proxy.
Signature: ________________________________________
Date: _________________________
Signature of Second Choice for Proxy:
I, __________________________, am willing to serve as the health care proxy if the first choice
cannot serve.
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The Alabama Directive Health Care form shares similarities with a Living Will. A Living Will is a legal document that outlines an individual’s preferences for medical treatment in situations where they cannot communicate their wishes. Like the Alabama form, it specifies whether a person wants life-sustaining treatments, such as resuscitation or artificial nutrition, in cases of terminal illness or permanent unconsciousness. Both documents aim to ensure that healthcare providers and family members respect the individual's wishes regarding end-of-life care.
Another document similar to the Alabama Directive Health Care form is a Durable Power of Attorney for Health Care. This document allows an individual to appoint someone else, known as an agent or proxy, to make healthcare decisions on their behalf if they become incapacitated. Like the Alabama form, it can include specific instructions about medical treatments and interventions. This ensures that the appointed person understands the individual’s preferences and can act accordingly when needed.
For those seeking the appropriate documentation, the California horse bill of sale template serves as a vital resource to ensure compliance and accuracy in ownership transfers.
The Five Wishes document is also comparable to the Alabama Directive Health Care form. This document combines a living will and a durable power of attorney for health care. It allows individuals to express their wishes regarding medical treatment, as well as their preferences for emotional and spiritual support. Similar to the Alabama form, Five Wishes encourages open communication about healthcare preferences with family and healthcare providers, ensuring that personal values are honored during critical moments.
A Do Not Resuscitate (DNR) order is another document that aligns with the Alabama Directive Health Care form. A DNR order specifically instructs healthcare providers not to perform CPR or other life-saving measures if a person’s heart stops or they stop breathing. While the Alabama form covers broader medical treatment preferences, a DNR focuses solely on resuscitation efforts. Both documents reflect an individual's wishes regarding the extent of medical intervention they desire.
Lastly, the Physician Orders for Life-Sustaining Treatment (POLST) form is similar to the Alabama Directive Health Care form. POLST is a medical order that translates a patient’s preferences for treatment into actionable orders for healthcare providers. Like the Alabama form, it addresses life-sustaining treatments and can be used by healthcare professionals to guide care. POLST is particularly useful for individuals with serious illnesses, as it ensures that their treatment preferences are followed in emergency situations.
Filling out the Alabama Directive Health Care form is an important step in ensuring your medical wishes are respected. Here are some key takeaways to consider:
By taking these steps, you ensure that your healthcare decisions reflect your values and preferences, providing clarity for your loved ones during difficult times.
The Alabama Directive Health Care form, also known as a living will and health care proxy, allows individuals to express their medical treatment preferences in case they become unable to communicate their wishes. This form is not mandatory, but it provides a way to ensure that your healthcare decisions are respected.
Any adult who is at least 19 years old and of sound mind can complete the Alabama Directive Health Care form. It is designed for individuals who want to outline their medical care preferences should they become incapacitated.
This form allows you to specify your wishes regarding life-sustaining treatment and artificially provided food and hydration. You can indicate whether you want such treatments if you are terminally ill, injured, or permanently unconscious. Additionally, you can list any other specific directions regarding your care.
No, naming a health care proxy is not required. However, if you choose to designate someone, that person will make medical decisions on your behalf if you are unable to do so. The form will still be effective even if you do not name a proxy.
If your doctor or hospital is unwilling to comply with your directives, they are obligated to refer you to another doctor or facility that will honor your preferences. This ensures that your wishes are respected regardless of the initial provider's stance.
Yes, certain limitations exist. For instance, if you are pregnant, the choices made in the form will not take effect until after the birth of your child. Additionally, your health care proxy must adhere to the guidelines specified in the form unless you grant them broader decision-making authority.
To validate the Alabama Directive Health Care form, it must be signed by you and witnessed by two individuals who meet specific criteria. These witnesses must be at least 19 years old, not related to you by blood or marriage, and not entitled to any part of your estate. Their signatures confirm that you are of sound mind when signing the document.