All adults have the right to make decisions about their medical care, including the right to refuse any life-sustaining treatment or procedure. These personal decisions are put into writing through documents known as "advance directives." An advance directive can be in the form of a Durable Power of Attorney for HealthCare, a Living Will, or a Comfort One declaration.
If you have an advance directive, please give a copy of the completed form to your physician or nurse to include in your medical record.
Advance directive forms are available by calling Memorial Hospital's Public Relations Office at (401) 729-2459. You may also download the forms below:
RI Durable Power of Attorney for Healthcare - English
RI Durable Power of Attorney for Healthcare - Spanish
Jewish Medical Directives for Health Care
Catholic Declaration on Life and Death Advance Directive
RI Living Will - English
RI Living Will - Spanish
RI Living Will - Portuguese
RI Living Will - French
MA Healthcare Proxy
Durable Power of Attorney for Healthcare
- You choose someone (your agent) to make decisions for you if you are ever unable to do so
- You express your desires concerning treatment choices for your agent to follow
- Includes all healthcare decisions, including withholding or withdrawing medical treatment
- Applies whenever you are unable to speak for yourself
- Can be flexible due to changing circumstances
- Easily revoked at any time--orally or in writing to your physician or healthcare provider
- Your decisions are in writing only. There is no agent to make decisions for you
- You provide instructions to your physician
- Refers only to withholding or withdrawing medical treatment
- Applies only when your physician determines that you are in a terminal condition and are unable to make treatment choices
- Is not flexible and may not cover every possible condition
- Is easily revoked at any time--orally or in writing to your physician or healthcare provider
Comfort One is a mechanism for emergency medical personnel to honor your wishes outside the hospital arena. To qualify:
What is a terminal condition?
- You must have a terminal illness and already have declared your wishes via a Durable Power of Attorney or Living Will.
- A physician must complete special forms which are kept on file with the Rhode Island Department of Health.
- An orange Comfort One bracelet & identification number are issued to you, which alerts emergency medical personnel to provide only supportive care--no resuscitative measures.
- Easily revoked at any time--orally or in writing to your physician or healthcare provider or by removing/destroying the bracelet
A terminal condition is defined as an incurable or irreversible condition that, in a doctor's opinion, would result in death in a relatively short time without the use of life-sustaining procedures.What is a life-sustaining procedure?
A life-sustaining procedure is any medical treatment that prolongs the dying process, does not include comfort care or alleviating pain. Examples include
- Artificial nutrition & hydration: A method of delivering food and water to a person who cannot eat or drink. A person may be fed through a tube--intravenously, through his nose or mouth--or directly into his stomach
- Cardiopulmonary Resuscitation (CPR): A medical procedure that involves forceful pressure on the chest, electric shock and special drugs to try to restore a heart beat
- Ventilator: A machine that helps you breathe if you cannot do so naturally
If you would like more information about preparing Advance Directives, please speak to your doctor or contact Memorial Hospital's Public Relations Office at (401) 729-2459.