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Advance Directives

You have the right to make decisions about the health care you get now and in the future.

Older couple sits at table with male doctor taking notes Older couple sits at table with male doctor taking notes

Our core values of Respect, Care, Competence and Joy are lived by all who work here and felt by all who use our services. At HSHS St. Mary's Hospital Medical Center, we want you to know you have the right to make decisions about your health care. This includes the right to accept or refuse medical or surgical treatment and the right to direct future health care decisions if you become unable to do so yourself. You can do this by completing an Advance Directive. 

Image of patient lying in bed with IV placed in back of hand

Information to help in Advance Directive and Do Not Resuscitate discussions

Facing Difficult Decisions brochure

Discussion Guides for Advance Care Planning:

We honor Advance Directives

An “Advance Directive” is a written statement naming a person of your choice to make health care decisions on your behalf. The Advance Directive will empower your selected representative to make health care decisions should you become physically or mentally unable to do so independently. If you have questions or would like to learn more about advance directives, please call 920-451-7265.

Advance Directive Forms

The following forms are available through the WI Department of Health Services:

  • Declaration to Physicians (Living Will)
  • Power of Attorney for Health Care (POAHC)

When do not resuscitate or "no code" decision is made:

Frequently Asked Questions

Yes. You may name an alternate who can make your health care decisions if your primary agent is unable or unwilling to act.
Yes. It must be signed by the person in the presence of two witnesses at least 18 years old. At the time the document is signed, no witnesses may be:
  • Related to the person by blood, marriage or adoption.
  • The spouse/domestic partner of the person.
  • The spouse/domestic partner of one financially responsible for the person’s health care.
  • An heir entitled to or has a claim on your estate.
  • A health care provider serving you.
  • An employee of the health care provider.
  • An employee of a health care facility in which you reside or are a patient, except for chaplains and social workers.
  • Your health care agent or alternate.
Some health care providers and physicians may have policies or beliefs, which prohibit them from honoring certain ADs. Discuss your AD with your providers to make them aware of your wishes and to determine if they will honor it. If they will not, you may choose another provider.
If you sign a new DPAHC, the prior one is revoked. Notify your health care agent(s) and health care provider(s) orally or in writing that you revoked your DPAHC. If the agent is the person’s spouse or domestic partner, the DPAHC is automatically revoked upon divorce, annulment of the marriage or notice of termination of domestic partnership.
It is not necessary to have both a Declaration to Physicians and a DPAHC. If you have both documents, make sure they do not conflict. If they do conflict, a health care provider will follow the instructions on the DPAHC rather than the instructions of the Declaration to Physicians (if the DPAHC is dated after December 11, 1991).
It is not necessary to have both a Declaration to Physicians and a DPAHC. If you have both documents, make sure they do not conflict. If they do conflict, a health care provider will follow the instructions on the DPAHC rather than the instructions of the Declaration to Physicians (if the DPAHC is dated after December 11, 1991).
A health care agent, acting in good faith, does not incur criminal or civil liability for health care decisions made under a valid DPAHC.
No health care facility or provider may be criminally or civilly liable or charged with unprofessional conduct for:
  • Certifying incapacity if certification is made in good faith after a thorough examination of the person.
  • Failing to comply with the DPAHC or the decision of a health care agent (failure of a physician to comply with the DPAHC or a decision of the health care agent constitutes unprofessional conduct only if the physician refuses or fails to make a good faith attempt to transfer the person to another physician who will comply).
  • Complying with the terms of a valid DPAHC if they don’t know it was revoked.
  • Acting contrary to or failing to act on a revocation of a DPAHC, unless the health care facility or health care provider knows of the revocation.
  • Failing to obtain the health care agent’s decision (this immunity applies if the health care facility or provider has made a reasonable attempt to contact the health care agent to obtain a decision but has been unable to do so).
  • Making a decision in good faith pursuant to the DPAHC.
It is the inability to understand information or communicate health care decisions. 
You still receive medical care even if you do not have an AD. You may not receive the type of care and treatments you want if you could still make decisions for yourself. If you cannot speak for yourself and do not have an AD, a physician or health care institution may ask the courts to appoint a legal guardian who would then make decisions for you.
You may revoke or redo a Declaration to Physician or DPAHC at anytime.
Documents signed in another state on or after May 5, 2004, are valid and enforceable in Wisconsin if they were valid in accordance with the laws of that state. The document must authorize your agent to make the same decisions for you that a health care agent in a valid Wisconsin document could make for you.
An AD is signed by you when you are a competent adult naming someone you trust to make your health care decisions if you are incapacitated.
The regular Durable Power of Attorney document is used for finances but does not include health care issues. (If the Durable Power of Attorney was completed prior to April 28, 1990, and includes health care decision-making ability, it is presumed to be valid.) The DPAHC addresses only those issues relating to health care.
Upon receiving a valid document, a health care facility or physician reviews the document to make sure it is valid. The document is then scanned into your electronic medical record. If you have been certified as incapacitated, that activation form is also placed in your medical record so that we can respect your stated desires consistent with applicable law.
After signed and witnessed, it is a valid document that remains in effect until it is revoked or until the expiration date (if there is one). If you have capacity, you continue to make your own health care decisions. It is activated if two physicians (or a physician and a psychologist) who have personally examined you sign a statement that you lack the capacity to make health care decisions. If you regain capacity, then one physician can deactivate your DPAHC and then you once again make your own medical decisions.
Your physician or other health care provider, your attorney, the Pastoral Care dept. at HSHS St. Mary’s Hospital Medical Center at 920-498-4282 or the Wisconsin Department of Health and Family Services at 608-266-5863. This information is adapted from the Wisconsin Department of Health and Family Services.
 
Keep your AD in a place where you and others can easily find it, but not in a safe deposit box. Make sure your family members or domestic partner, physician, health care provider, hospital and lawyer are aware that you have an AD and give each of them a copy of your document.  It is ideal to have the document in your medical record.
Anyone who is at least 18 years old and of sound mind, but not: your health care provider, an employee of your health care provider, an employee of a health care facility in which you are a resident or patient, or a spouse/ domestic partner of any of the above unless that person is also your relative. 
No health care agent, unless the agent is the spouse or domestic partner of the principal, may be held personally liable for goods or services purchased or contracted for under a DPAHC. The medical cost liability would be the same as if the care was provided as a result of the person’s decision.
It speaks for you when you cannot. It tells what treatments you do or do not want and who will make the health care decisions for you when you cannot.