At St. Mary's Medical Center our primary focus is the dignity of each patient. We seek to enhance quality of life primarily by preventing illness and restoring health, but we also recognize that alleviating suffering and caring for the dying are essential aspects of our mission.

Your Choices
Although each situation is unique and life decisions are never easy, St. Mary's Medical Center encourages you to consider some very important questions now, before you are faced with what may be a very difficult decision.

• What will happen if you find yourself, or a loved one, with a chronic or terminal disease that fills every day living with pain and suffering?
• What are your options for treatment or life support?
• If your heart or breathing stops, do you want to be resuscitated? (i.e., have efforts made to restart your heart or breathe for you artificially?)
• If a loved one should be in this situation, what would he/she choose?
• Does the attending physician know your wishes?
• What can you do in advance to assure that your wishes are carried out in the event that you are not able to make your own decision?

Documenting Your Choices in Advance
Patients are usually able to make informed, deliberate choices about their own treatment. These choices can be expressed in advance, before you are unable to express your wishes due to progression of an illness or other unanticipated problems. There are three advance directive documents available in California to convey those choices they are:

1. Advance Health Care Directive: This document states your desires and appoints an individual to make decisions concerning health care in situations where you are no longer able to make them for yourself. This document is legally binding, both on the person appointed as Attorney in Fact and upon your physician.
2. Natural Death Act Declaration: This document allows you to provide general guidelines regarding the extent of your health care. It can be used in the event you become incapable of making decisions. This document, part of the California Natural Death Act, directs physicians not to continue treatment. It is legally binding on your physician.
3. Living Will: This document allows you to provide general guidelines regarding the extent of your health care; it will be used if you become incapable of making decisions. This document is regarded as an expression of your choices; however, it is not a legally binding document in the state of California.  Contact your chaplain, case manager, discharge planner or social worker to find out where you may acquire this form.

Ethical Questions and Concerns
Conflicts that may arise in regard to decision-making about health care and treatment may be referred to the Bioethics or Ethics Committee. Please notify your physician, nurse, case manager, or patient relations representative to initiate the process.