An advance directive is a written statement, such as a living will or power of attorney for healthcare, that states a person's wishes for medical treatment should they become incapacitated.
Advance directive counseling typically is provided by a chaplain, social worker or case manager. Primary care physicians and specialists also discuss advance directives during office visits, but such conversations often are rushed.
"We are not aware of any other health system offering advance directive services during a dedicated one-on-one consultation with a physician who has a background and training in medical ethics," said Paul Hutchison, MD, MA, who will see patients in the clinic. Dr. Hutchison is an assistant professor in Loyola Medicine's division of pulmonary and critical care medicine.
Dr. Hutchison has studied and conducted research on ethical issues related to end-of-life care. He has a master's degree in philosophy, with a concentration in bioethics, from Georgetown University. As a specialist in pulmonary and critical care medicine, Dr. Hutchison has day-to-day experience in end-of-life care in the intensive care unit.
The Advance Directive Clinic is held at the Loyola Outpatient Center in Maywood, Illinois. Each appointment lasts 30 minutes. Dr. Hutchison encourages patients to bring family members.
During the first part of the visit, Dr. Hutchison talks to patients about their values and what type of care they would want. He asks specific questions about a patient's personal sense of dignity and preferences for how they would like to be treated by their healthcare team.
Dr. Hutchison then walks the patient through Illinois' Power of Attorney for Healthcare. In this form, the patient designates an agent (a family member or other trusted person) who would have the authority to make healthcare decisions in the event the patient was incapacitated. The form also enables a patient to specify the type of care they would wish to receive. For example, a patient could state they do not want to have their life prolonged or to receive life-sustaining treatments if their agent believed the burdens of such treatments would outweigh the expected benefits. Alternatively, the patient could state they would want to have their life prolonged to the greatest extent possible in accordance with reasonable medical standards.
"We suggest filling out an advance directive when you are healthy, when you are thinking clearly and can make informed decisions," Dr. Hutchison said. "If you wait until you are ill, you may not be thinking clearly enough to complete an advance directive and may miss the opportunity."
Dr. Hutchison said there is a misconception that initiatives such as an advance directive clinic have the goal of limiting aggressive therapies. "Instead, the goal is to elicit the patient's values and priorities so the medical team can help them make the best decisions possible," Dr. Hutchison said. "We respect the dignity of every human being and recognize the importance of an individual's autonomy and ability to make decisions for themselves."
The Advance Directive Clinic is one component of Loyola Medicine's program for trust and dignity in medicine. Other components include initiatives to improve care for terminally ill patients in the ICU and research on the use of advance directives and palliative care.
Loyola Medicine is a regional Catholic healthcare system, and Dr. Hutchison said the Advance Directive Clinic conforms to the church's Ethical and Religious Directives for Catholic Health Care Services. Directive No. 24 states: "In compliance with federal law, a Catholic healthcare institution will make available to patients information about their rights under the laws of their state, to make an advance directive for their medical treatment. The institution, however, will not honor an advance directive that is contrary to Catholic teaching. If the advance directive conflicts with Catholic teaching, an explanation should be provided as to why the directive cannot be honored."