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Advanced Directives/Living Will

Your Admission to Daviess Community Hospital

Federal regulations require hospital personnel to inquire as to the presence of an Advance Directive. This includes a living will or durable power of attorney with a healthier clause. Information on Advance Directives is provided to every patient upon admission.

An identification bracelet for your wrist will also be prepared. At this time, you will be taken to the nursing unit or department to which you are assigned. Nurses and/or technicians will interview you by asking questions about your health. Sometimes, these same questions are asked more than one time to ensure accurate information. These questions may concern your diet, allergies, personal habits, and other factors that will apply specifically to the care you receive.

Advanced Directives


The Patient Self-Determination Act of 1990 requires all hospitals participating in Medicare or Medicaid to ask all adult patients if they have an advance directive. An advance directive is a statement, either verbal or written, in which a person indicates in advance their choices about medical treatment or designates someone to make such choices should they become unable to make these decisions.

An advance directive can help doctors and staff who are providing care to know your preferences for medical treatment. Daviess Community Hospital social workers and pastoral staff are available to answer questions if you would like more information.

Living Will

A living will is a document that provides instructions for your care in the event of a terminal condition. This condition may be the result of an incurable injury, disease or illness, and death is imminent without life-prolonging procedures.

Competent adults have the right to control the decisions related to their medical care, including life-prolonging procedures. The living will serves as the final expression of your right to refuse treatment and accept the consequences of the refusal.

The living will directs withholding or withdrawing of procedures that artificially sustain vital functions and prolong the dying process. It is your request for permission to die naturally with only the provision of appropriate pain easing medication and comfort care. In addition, when making a living will, you have a choice about whether you want to have artificially supplied nutrition and hydration. You can also elect to have your healthcare representative or your attorney make this determination for you.

You may execute a living will if you are 18 years of age or older.

The living will must be:

  • Voluntary
  • In writing
  • Signed by you or another person in your presence
    and at your expressed direction
  • Dated
  • Signed in the presence of two or more competent witnesses who are at least 18 years of age

A living witness may not be:

  • The person who signed the living will on your behalf
  • Your parent, spouse or child
  • Entitled to any part of your estate
  • Financially responsible for your medical care

You should notify your physician about the living will. Your physician will then place a copy of it in your medical record. Legally, the living will does not obligate your physician to withhold or withdraw life-prolonging procedures. However, the living will is evidence of your desires and will be given great weight in determining your intent if you are unable to give directions regarding your care. A living will is not in effect during a pregnancy.

Revocation of a Living Will

You may revoke your living will at any time by:

  • A signed, dated, written document
  • Physical cancellation or destruction of a living will by you or another person in your presence and at your direction
  • An oral expression of intent to revoke the living will

The revocation is effective when it is communicated to your physician.

The following is approved by the Indiana Code:

4101 Living Will Declaration.pdf

Living will form in Spanish

Please view our Patient Guide for more information!