Hi Jane, my name is Ginger and I'm here to help you facilitate your advance
directive today. Before we start I'd like to go
over this facilitation process form with you.This form kind of lets you know
a little bit about the process of facilitation, why advance directives are important, and
most importantly it lets you know what my role in the process is is going to be.
I'm not a doctor; I can't give you medical advice. I'm not a lawyer; I can't
give you legal advice. My role is just to help you put
your wishes and your wants and your needs for your future health care planning on to
paper. So, if you don't mind could you
give this a review and then sign at the bottom? Okay, great thank you let's start
Let's start, why don't you give me an idea of what your case manager has already
told you about advance directives?
>>Not a whole lot just
that if anything happened to me and I was in the hospital unconscious or something
it would be a way to let people know if I wanted to be on a breathing machine or get
shocked to bring me back or...
>Okay that's a really good place
to start the advance directive form that we're going to fill out today will cover advance
planning for your medical health care, your end-of-life care which is what you were just
talking about, and mental health care.
>>Mental health care?
But I'm not crazy.
>>No, by filling this out you're
not saying that at all the advance directive with instructions
for mental health care goes into effect not only if someone is diagnosed with a mental
illness but also if they sustained a brain injury or if they develop dementia later in
life so it really has a lot of broad applications. So kind of going off of that
let's discuss the idea of capacity really quickly.
Capacity is what next your advance directive go into effect, or rather the lack
of capacity. Capacity just means that you have
the ability to make informed decisions about your own health care.
So, if you are not able to do so that is when your advance directive would
go into a place and be able to speak for you. In medical situations, like you
going into the hospital unconscious, that would be really cut and dry and of course
your advance directive would go into effect because you're not conscious you're not able
to make your own decisions. But in circumstances like if you
were to begin suffering from dementia in 15-20 years then your advance directive might go
in if you reach a place where you no longer lucid enough to make your own decisions.
And to make that distinction to doctors would need to examine you to determine
your capacity and sign off and on the fact that you were incapacitated before your advance
directive would go into effect.
>>So two doctors would have to sign?
>Yes to doctors would have to
sign off on the advance directive for it to go into effect.
Only one doctor would have to sign off on the fact that you have regained your
capacity to turn off the advance directive once when it had been activated.
So, let's just go ahead and let's start filling this out if you don't mind would
you put your legal name right here? Okay, wonderful let's move on
to the first section which is appointing an agent
An agent is the person who you can choose to appoint to make healthcare decisions
for you in the event that you are not able to make them for yourselves have you thought
about anybody that would be good in this role?
>>My mother
>Have you talked to your mother about it at all?
>>No I don't know where my mother lives right now. I haven't gotten in touch
with her in a long time.
>Okay well let's put your mom on the back burner for a second and
just talk about what you might want to look for in an
agent. Good agents know your values,
what it is you would want if you were experiencing any kind of crisis,
and they're easy to reach. so if you don't know your mom's contact information
right now, then she may not be a great agent for you.
if you are able to get her contact information, she is the person in your life
that knows you best and knows what you would want, then yeah she would be a good Agent.�
but for now let's think about other people that you may want to include
that are easily reached and know your values and wishes.
>>Does it have to be a relative or a family member?
>No it doesn't. You can choose friends you can choose significant others
that maybe you're not married to you can choose coworkers any of those as long as they know
you very well would be good agents. >>Could you be my agent?
Unfortunately no given my role and given the fact that I don't know you well
enough to know what you would want in a crisis means that I would not be a good agent.
>>What about my case manager? She knows me.
>Unfortunately most CSBs have policies preventing case managers from acting
as agents so you may want to think about other people that that would be more appropriate
agents like other friends or coworkers.
>>Well I have a friend that knows
me pretty well but she is bipolar.
>That's not necessarily a problem;
just because she has the diagnosis of bipolar disorder doesn't bar her from acting as your
agent as long as she herself has capacity and is lucid at the time that
your advance directive goes into effect she could be a great agent
>>Okay well when I see her maybe I can talk to her about
>Okay that's fine and we can hold off on completing the agent section until
you had a chance to talk to her or talk to your mother about the advance directive self
and about what your wishes are if you do talk to them and it doesn't seem
like either of them would be a good agent for you then you don't have to include an
agent and your advance directive lots of people just let let their
written instructions speak for them. I do believe that for a lot
of people having an agent appointed it's a good way to make sure that their advance directive
is enforced but it's not necessary so if
that's something you don't want to include you don't have to include it.
Also if you speak to your mom and your friend and you want to include both
of them somehow and your advance directive, you can appoint one of them as a primary agent
and one as a successor agent in case the primary agent isn't
able to act as your agent because maybe she's out of town or she herself is ill and
in that event the successor agent would be called and they would start making decisions.
>>Well could I have both of them as my agent?
>We don't really recommend that
you have two primary agents just in case there is a difference in opinion
that could slow down you getting the healthcare that you want if the two of
them battle over making a decision.
>Hey Bonnie
>>Hey Dana. It's good to see you again
>Thanks it's good to see you too. So I know after last time we met
and we talked about picking an agent and stuff.
How did you feel after that session?
>>Well I had to go home and think about it a little bit and I called my sister
Donna and she is happy to do it so I'm excited.
>Excellent so we can fill that in with her.
Did you bring her address and phone number?
>>I did.
>Excellent so we'll fill that in
and did you think about if Donna is not available is there a second person?
>>Oh gosh.
>There doesn't have to be but
>>I think her husband he's a lawyer so it would be good to have my agent be a
lawyer right?
>It doesn't have to be. It more
depends on your relationship with him and do you have a good relationship with him and
do you trust him?
>>I do yeah
>So why don't we put your sister down Donna as your agent and will talk to
her her husband?
>>So do I fill that out here?
>We can do that together. Why don't we go through what we're going to go through
today and before you leave today will pull out the information and fill it in
so now that we've chosen Donna to be the person to make decisions when you
can't now we need to talk about what
sort of decisions you feel okay with her making with for you and if there are any limitations
on that. >>Okay.
>Okay, so we're going to go through
these one by one because each one is important and its own way and you can choose to say
"no, I don't want Donna to have the power to make that decision for me if I can't"
and then we'll talk about what that might do as far as her power goes, okay?
>>Okay. >So the first one is the most
basic one and that's a give consent or refuse any sort of medical treatment
and of course we're always talking about things that you can't can consent or
refuse on your own during a time when you may be
sick or injured and you're not able to make these decisions for yourself
and it's to consent or withdraw consent or say no to any type of healthcare
and it includes things like breathing machines and tube feedings as well as things
that aren't so dire you know all the way up to medications,
surgery and things like that if you're not able to make that decision
>>Okay, those are some big questions. >They're very big questions
and that's a really big part of this section on the powers is to be able
to say yes or no to types of medical treatment. Is there anyone in particular
that makes you a little nervous or you want to talk about or have questions about?
>>Oh I don't know the whole end-of-life decisions are pretty scary so I need to ask
more questions about that maybe later. >Okay and we do get to that
later. This would give your agent Donna the right to make those final decisions when it
came to it but there's another section in
the advance directive where you actually can put down your own wishes
and at that time you can decide if you want Donna to have to follow your wishes
or if you want to give them as guidance and let her make the decision so
you do have options when it comes to that. Okay?
So how about if we leave this one for now as it is and then when we get
to that end of life section and we really start to talk about
those decisions then we can decide where you want Donna to come in
Does that sound okay? >>That sounds good
So, let's go to number 2 and that's to get copies of or be able to see copies
of your medical record talk to your doctor about confidential medical information release
that information like if you have to go see another
doctor to be able to sign the paper so they can release that information so that's the
second power. >>So I don't care if she sees some
of my medical records but others are private like my therapy records and my
psych records. I don't share those with my family.
And I will say that this wouldn't include things like psychotherapy notes like
the notes your therapist takes when they're working with you
This includes more like your medication records your treatment records
Psychotherapy notes are treated very differently from other types of medical
records so if that's what you concerns you it's good to know they are treated differently
>>It does because I talked about her and I don't want her to see it
>Right right and we can put in here that we don't want her to have access
to your therapy notes even though she wouldn't under
the law we can make it very clear that's what you want
so down here where it says additional powers if any we're going to put down that
she does not have access to therapy notes so that makes you feel okay about
number two? Number three is to employ ore
discharge your health care providers- hire and fire your doctors and
that comes into play a lot of times if you need a second opinion and she
is to find another doctor to get a second opinion
before she makes her decision about something
firing a doctor might be an instance of he doesn't want to follow your wishes
and as your agent she can say, "Well, if you're not going to follow Bonnie's
wishes then I'm going to have to find another doctor."
>>I like that. okay good
>Number four is to say it's okay to admit you to a hospital or hospice or nursing
home or assisted living facility, basically any facility other
than a mental health facility because that's treated differently
So if you're in a situation where you can't make your own decision and you need
to make your own and you need to go to hospital to go for medical treatment
then it would be okay for your sister to go to the hospital and sign those
paper at registration you know how you have to sign
papers when go you to a hospital or if something were to happen you go to hospital and then
you go to a rehab center then she would be able to you know
sign you into that as well only as for as long as you aren't able to make those decisions
for yourself >>But what if I think we're going
to talk through all of this and it sounds like we'll talk about this later but what
if she makes decisions for me but I would not have made
>Well it's important that you choose somebody you think will follow your instructions
Donna would be required under the law to follow any instructions you that
you put in your advance directive if you think there's a chance
she wouldn't then that would be something you would want to talk to her about
and make sure that she understood that would be what if there would be expected
of her and it would be important that
things that are really important to you are put down in writing so that she has to follow
it. >>Okay okay
>Does that help? >>Yeah
>>So that's you really have to keep an open line of communication with Donna
to really make sure she makes she knows what her role is in this
>>She just has been through a lot of medical things herself and she has some
really strong opinions and sometimes her opinions are different from mine
She'll do what I ask her if I tell her
> Alot of times family members will they just need to know and
that's why it helps to put it in writing because then it's unambiguous and
everybody knows what you want. >>Okay
>Good Now, Number 5 remember how we
said that mental health facilities are treated differently
so number five is where we talk about mental health facilities
So if you're in a situation where you're not able to make your own decisions
and Donna thinks that you need to
go to a mental health facility and you're not able to sign yourself
then this would give her the authority to do that on your behalf
>>I don't want to go to a mental health facility I don't want to go to the
state hospital. Do I have to give her this power?
>No, none of these powers are obligatory none of them are required that's why we're
going through them so you can choose so with this power you kind of
have three options: one is that you don't give her the power at all and we cross it out
>>That sounds good. >Let me just tell you the other
two just so you know and the other power the other
option is you can say well Donna can do that she can take
me to a mental health facility and sign me in
as long as I'm not objecting to it and the third one is even if I'm objecting
I want her to be able to sign me in >> But what happens if she if she
just gets angry at me because of my behavior and she wants to sign me in?
> And that's a common fear that people have so what the law has done
What the legislators have done is they have put some protections in there
for us and it says that you have to be diagnosed with a mental illness,
a doctor has to decide that yes you do you would benefit from inpatient treatment,
a hospital has to be willing to accept you meaning that yes they agreed
you need inpatient treatment and it can only be for 10 days
>>So she is not in charge she can't just check me in they have to think that I
need to be checked in >That's correct
>> I need to think about that one some more
> and I know that's a very big decision so think about that one
>> and we can talk about it next time we get together
> Number 6 is allows Donna to continue being your agent once you get to the point
where you lose capacity to make your own decisions. Remember the last time we talked
about capacity the ability to make your own decisions?
So, if you are sick and you're injured and you need to make your own decisions
number 6 power says Donna can still be in charge
if I'm not able to make my own decisions and I'm saying I don't want her to be my agent
anymore.
>> These are really hard questions
> They are very hard questions >> And it's hard to think about these things
like for the future.
> I know I know, so let's talk about
> What that would look like and you don't have to make your decision
today but let's talk about what that would look like
Let's say you get into an auto accident and you hit your head okay and you
got a bruise on your brain and not making a lot of sense you're
talking about things that don't make sense. You're obviously not able to
make your own decisions. Donna walks into the room and
starts talking to the doctor and you say you don't know this
person, you've never seen her before and you want her to leave and not
make decisions for you. With this number 6 power in place
she would still be able to make decisions for you
until that bruise on your brain went away and you were able to make your decisions
again. Without that power it could be
that she could not be able to make those decisions for you
>> Who would make those decisions then?
> Well if you had a successor agent then that person would come in but what if
you said the same thing about him? And then it would go through
legally who might make those decisions for you
And I don't know if you remember the training but if we don't have one of these
in Virginia what happens is that the law looks that your family
>> I remember. > You remember
>> I don't have a lot of control over that
> So when we talked about that since you're not married, you don't have any
adult children, it would fall to your parents
and I know that was a real concern for you. >> Right yeah okay
This one's a little scary too I think I want to give this to her but I'm
not positive. >Well I want you to think about
it because I don't want you to do anything spur-of-the-moment think about it
and we can talk about it again the next time we're together
>>Alright. >You know what I better start
of the ones we need to talk about again because >>That's a good idea
>The first one was the end of life
The mental health facility and number 6 okay
>> Gosh it feels like I'm not ready to answer anything
>Well I'd rather have you do that then give an answer you're not sure about
We can meet as many times as you need to
Number seven and number eight are kind of similar so we're going to do those
together. One they are both about healthcare
research, medication trials, drug trials
experimental treatment. One deals with if you are doing
experimental treatment and the doctor says I think this might help
and the other is well it's not going to be a cure for Bonnie
but we're studying whatever it is we're and we'd really like some information
for our research purposes. >>Kind of like a guinea pig?
>Kind of like a guinea pig yeah. >>So I don't really want to be
a guinea pig for no reason at all but I don't mind having research if it might help me
So maybe yes Can I split those up?
>Yes you can So will say yes if there's a
prospect or chance it may help you will say yes to that one and no to the one that's just
for scientific purposes. >>Wait but that might help someone
else right? >>It might. Any medication that
has been put on the market has gone through this process
but it's done on people agree to have it done and it's a there's no right
or wrong answer it's just what you feel most comfortable with
>>But they wouldn't do research on me that would hurt me right?
>Not if they knew it would hurt you and they have to go through an approval
process and stuff like that to get to the point to experiment on people
>>I like to help people. I will say yes to both
> Okay and if you ever change your mind again we're going to meet again so you
can change your mind at any time. >>You make this easy
>Oh good! That's my job. Just a couple of more to go
Number 9 is to make decisions about visitation if you're in a hospital setting
it would be able to say who can come see you and who can't
There's a couple of options here you can cross out that power and visitation
is more open and anyone could come visit you or if you think there is anybody
in your life that you wouldn't want to come visit and you want Donna to kind of step in
and keep that from happening then we can give her that power
>>So I've been to the hospital before for psychiatric reasons and
I hope that I never have to go again but if I do there's people that I don't
want to know that I'm there but if I'm there because I was
in a car accident and I got a bruise on my brain I want them to come visit me so can
we separate that out? >We can and there's another part
of the document where we can actually put that in writing
That if you're in a medical facility for a medical purpose you want to open visitation
but if you're in a psychiatric facility these are the people that you would want or would
not want to come we can put that in writing
So would you like to give Donna the authority over that to make sure that
happens? >>Yeah I want to make sure that
happens >And number 10 is sort of a catch-all
and it says that Donna can take any
legal action to make sure these things occur and how that comes into play
is that she can make decisions for you by number one
but number 10 says she can actually can sign theconsent form that allows that
to happen >>So I kind of need to say number
10 to make number one work? Okay number 10 is fine
>Okay that is what I thought and then under additional Powers
were going to put down the instruction about no access to therapy notes
>>Right >as a limitation
>>Thanks for remembering because I forgot already
>That is what I'm here for.
>All right Susie so we have talked
a lot about the powers you have chosen to give to Matt your agent
or a couple of them you chose not to.
This is a power that's a little bit different.
Let me preface it with saying in Virginia you can give Matt and you chose
to give Matt the power to hospitalize you for up to 10 days.
In Virginia you can at some point even though you've given him that power object
to it and the state has to follow your
objection, even though you've given your
agent the power so some people know themselves
when they're not doing well that they sometimes object to
things that they really want anyway so if you have an opportunity
we call this the Ulysses Clause. I'm not going to get into why
we call it the Ulysses Clause unless you want me to; its sort of off topic.
It's the option for your agent to do a couple of things even over your objection
and those couple of things you can choose one you can choose
the other or you can choose both. Those couple of things are treat
you over your objection or hospitalize you over your objection.
Can you think of why you might want that?
Some people I know know themselves they seen themselves
when they're not doing well before and they may want something but
they start getting really anxious about it or really not trusting people about it
So they say no even though if they were doing okay they would want that
treatment. And so this is written into
Virginia advance directives to give you the option
of whether if you know yourself well enough that you would say no
even though you want it do you want to give someone the power to treat you
even though you said no. >>It's a really big question
>Its a really big question >>Yeah, I'm just
I'm just not quite sure about it
Cuz you know I just don't want to go into the hospital
no matter what that's like my thing I just
I'm over it I don't want to go to the hospital
>Okay maybe we need to go back to the powers you gave your agent
because you said your agent can hospitalize you for up to 10 days
>>Yeah but like you said that's if I say no he can't right?
If you say no he can't but if you've been make the meet
the criteria to be hospitalized you have to go through the TDO
process and be committed so that can be kinda traumatic
So this is a way to help sort of avoid that traumatic experience for some
people. >>I guess it's something to think
about then but yeah I think I'll just have to
think about it. >It's definitely something I don't
want you to answer today. It's definitely something I want
you to go home and talk to some people who have seen you when you're not doing well
maybe and can hear from them their experience of you
and think back in your own experience what it was like if you have that
>>I have >and talk about it a little bit
with people you trust and we can readdress it next
week. There's two questions so you
can say yes to one or yes to both or yes to the other.
One question is do you want your agent to have the power to authorize treatment
even over your objection and do you want your agent to
have the power to authorize hospitalization even over your objection
>>Right Yeah it makes sense I think I
think I would be okay was treatment over my objection
but I would have to think about the hospitalization a little bit more.
What I'm seeing here on this is what's this box for?
That's a great question, so we talked a little and the
beginning how you can just write your advance directive
You don't have anyone nobody has to tell you your sane
or you're well enough to write it. anyone can write an advance directive
your presumed sane in the state of Virginia. And this still presumes you
know what you're talking about but those two questions are such big questions
do you want to be treated or hospitalized over your objection that the
state wants to make sure you understand the implications of your decision.
So this box if you answer yes to either one of those two this box you need
to get a signature from a physician or a licensed clinical psychologist
that says you understand the implications of your decision.
it doesn't have to say you're healthy or not healthy
you just understand the implications of those decisions you made.
and we can talk about that next week you wanna get back together next week
and talk about your decision on these two questions.
and then if you choose yes we can talk about
who you are thinking would be good to have that signed.
Maybe your psychiatrist or your therapist?
>>Now I'm going to go see my dentist and the next couple weeks
If I want to do this can I get him to sign it?
>Well your dentist is a physician. Maybe
Is your dentist a physician? Okay ask me the
question again. >I think you can go around that
by saying your dentist can can give you
some forms of health care treatment but they aren't the best because
Okay ask me the question again. >>Now I'm going to go see my
dentist in the next couple weeks so should I just get him to sign off on it cuz I'm already
going. >Well your dentist does some treatment
for you some medical treatment for you some dental treatment for you
but this is really better to have a physician who understands these questions
and the implications of them and understands
your your thought processes >>Right okay well I guess that
makes sense. So I could get it done here?
I could get it done at the CSB
>Sure you see your provider is at the CSB so that would be great.
Next time we meet if you decide to check either one of those or both of those
we can make sure that the next step is as good for your provider at the CSB.
You don't even need an appointment I'm sure they can just sit down with you for
2 minutes and sign it. >>And its just this thing? They
don't have to go through the whole form?>They don't have to see the whole
form at all at some point you may choose to file this form with the CSB
but there's no requirement that the person who fills this out and signs it
sees the form. They are just addressing those
two questions particularly. >>Well I have to think about the
hospitalization piece but we talk about that one before I come back
Great, I'm glad you're putting some thought into it instead of just making
a snap decision. Cool
>Okay Michael, so we are done with the agent portion of the advance directive
and we're going to move on to healthcare preferences and instructions
and this is where you can write down
what it is that exactly that you would want in terms of your medical health
care in terms of your mental health
care in terms of your end-of-life care that would inform the doctors
and your agent because you decided to appoint
an agent after all so the first part of that is
going to be current healthcare conditions and treatments
Do you have any physical or mental health diagnoses that we should be aware of?
>>Yeah well I have diabetes and I have high blood pressure
And my doctor told me I have bipolar disorder too
>Okay so we'll make sure to include that
and are there symptoms that usually arise around the time that
you're getting more sick with any of these that we should put down so people
can be aware. >>I get kind of faint when my blood
sugar gets low. I don't really like to be around
people when I start to get depressed I kinda like pull away
>Okay So we'll make a note of that
so when your agent or somebody sees this they know that that's maybe when they should start
intervening. Now as far as medications go
do you have any idea what all the medications and dosage that you're currently
taking are? >>Well, I brought a list I think
this is the most up-to-date one. It changes a lot my doctor change
my medications a lot. >Well if that's the case where
are you have kind of a frequently changing medications
the best thing to do or a good option for you
maybe to not necessarily write it directly on the advance directive
but to have another list of your medications and dosages
as an appendix because otherwise every time you change your medications
you need to come into every version of your advance directive
that anybody has on file and make sure that information has changed
so everybody has the best most up-to-date version of the advance directive.
so that could be something for you to consider
You don't have to decide right now
You can decide to fill it out the advance directive later if you think that
it's important you include that information directly on there
Now other important information regarding medications do you have any that
you are allergic to? >>Any medications that I'm allergic
to? >Yeah
>>No sometimes I don't feel well with some of them
but I have other allergies. Do they need to be on here if
they're not medications? >It's a good idea to put them
on there even if they aren't medications just so your doctors can be aware
>>I'm really allergic to peanuts and if I get stung by bees I could die
so I'm really allergic to both of those
>So we'll make sure your doctors are aware of that
Now, are there any medications that give you side effects that you're not
okay with? >>I can't remember the names of
them but there are side effects that
I don't like to have, like sometimes these medications
make me feel kind of like a zombie and I don't like that at all.
And and I also you know I got a girlfriend
and sometimes the medications they don't let you know so medications that
do that I don't want that either >And that is the case with a lot
of medications used to treat bipolar and that kind of thing
So since you don't remember what medications those are right now
I think it might be a good idea for you to next time you talk to your doctor
see if he can flip back in your medical history and
make and give you a list of which ones those were
that you reported those negative side effects
with so we can put those on there as well as the side effects they
cause so the doctors know why it is you don't want them
not just that you don't want them
>>That would be great >Okay
>So Dana now that we talked about your current health conditions
and your current treatments and allergies and things like that
We also have the opportunity to authorize different groups of people to know
about your treatment in case you get sick in the future
in case you're hospitalized we can let
other people know and you can authorize that right here
One thing that people like to do is to include their primary care physician
which might be a good idea because they kind of have a central location
if they find out about you being hospitalized or you not doing so well they
have information they can send out to other people
other relevant people. So do you want to add your primary
care physician here to let him or her know if you gone help downhill a little bit
>>Sure, do you need address and phone number?
>Yeah, a name and phone number would be great if you have that
>>I have a card >You have a card? perfect
>>Yeah >And this is your primary care
physician, correct? >>Yes
>K great. >>Can you believe his name is Doctor
Hurt? >>That is something else isn't
it. Well we also have the chance
over here to add another treatment provider, not just your primary care physician
but someone else if you like someone else that is one of your doctors
in case you think they need to know if you're hospitalized or if you get
sick. Is there anyone else, any other
provider you think would be good to put here? >>Well I had a heart transplant
5 years ago so I really make sure my cardiologist knows everything
>I think that's a great idea to put your cardiologist down
because it is pretty serious and we'd want to let your doctor know if you're
having any other treatment done. Do you have your cardiologist's
information here? >>I just took the card out of my
wallet this morning and put it on the refrigerator so I wouldn't forget my appointment
so I'll have to get it for you >We can do that at a later time
but let's make sure to put that down that seems pretty important
any other treatment providers, any other doctors you have, a psychiatrist
or psychologist that you want to add to this? >>Yeah I have a psychiatrist I
only see him every 6 months I see my therapist every week so that might be better
>Yeah, it sounds like maybe your therapist would be a good person to add to
the to this list. Do you have that information
with you or do you want to punt that to next week?
I'll have all that information with me when I come back next week
and will add both of those your cardiologist and your therapist right here
so not only can we authorize these providers to receive information about
your hospitalization or any sickness that you have
but we can also add other people too
Anyone close to you that you may want to add to let know if you're not
doing so well? Can you think of any other people
in your life that maybe aren't a doctor but
someone important that they find out if you're not doing well?
>>Well I want my boyfriend to know I want him to know
and I guess my boss because I don't want to lose my job if I'm in the hospital
Let's tackle those one at a time. So, you would like your boyfriend
to know if you have any sort of hospitalization? Mental health or medical and
just kind of be aware of that >>Okay
Well no he doesn't know he knows about my heart and everything but he doesn't
know about the mental health. >Is that something you want to
keep from him or is that something you want to let him
>>Well for right now we haven't been dating that long so I don't want him
to think I'm crazy or anything so I just haven't told him
>Well we can make that happen if you like we can make a little note here
that we'd like for your boyfriend can
be informed if anything goes downhill as it relates to medical care
but if you don't want him to know if anything if you get sick with mental
health issues then we can add a note here to
not be contacted the situation. >>I think that's a good idea for
now until we get to know each other. >And again we can change this
in the future so if you get to the point where
you feel comfortable with that then we can add him to know about both
Do you want to put his information down now or later?
>>Well I can give you his name but his contact information is in my phone
I don't have it memorized. >Got it so we will add him when
we do the two other treatment providers we talked about
and then you said your boss the second one you mentioned
That sounds great just to let your boss know when you're not available
I'm curious to know is just to verify your boss is someone
you do want to be aware if you are sick both medically or mentally
if you're hospitalized you want your boss to know both of those is that correct?
>>Well I don't want to lose my job so I feel like he has to be told something
I don't want to just not show up for work
>But do you want him to be aware of why exactly that is why you're not at work
or do you just want and to be aware
that that you're not at work for some sort of health reason?
>>Yeah I mean he doesn't have to know everything just that I'm not coming to
work >Well I think we can add that
in the same way that we kinda made a note about
your boyfriend we can make a note about your boss too
that your boss should be contacted without many details given
so if you want to hold back some information
just let him know that your boss know that you will not be in
we can do that but leaving out these other details if you feel more comfortable
with that. >>Who would call him though?
>Your agent is the person we would hope to call
and if there's actually someone else you'd rather have call your boss for
you we can add that in as well, we can add them in as a contact
person to be contacted if you get sick and then make a note that that person should call
your boss. How would you like to navigate
that? >>I'm okay if my mom calls
>Is your mom your agent? So she'll already get the information
Anyone else you can think of that you want to have notified if you get
sick? >>Well, my friend Linda and then Becky
at work she's really worried about me and my cousin Melissa
but if Melissa gets call then somebody needs to call Shelly
because she'll feel really bad if she doesn't get a phone call
so it seems like you have a lot of people that you like to keep to be aware
if you're not a doing so well. Is your mom your agent is she
may be a good person who would know all of those people
and we could get her to make those calls rather than relying on the doctors
who are pretty busy in the hospital to make the call for you
>>Mom could do that Mom could do that
>I think that would be good if we had your mom do that
just because we want to have the doctor's place the fewest calls and then
from your mom as an agent
just calling other people like Linda and Shelly and those people
>>Okay we can do that >Okay I think that's all proceed great
>In this next section is going
to cover medication preferences and refusals. So here is where you can let your
doctors and your loved ones know if you're having a crisis which
medications you would prefer be tried first and which medications you refuse
outright. So let's start with medications
that work especially well for you when you're having any kind of
crisis or illness. >>Well you know I have anxiety
attacks and when I get this anxious feeling
sometimes if I smoke a little weed it really helps it calms me down
makes my anxiety go away
Can I include that on there as a medication?
>>Well here is where the options in your advance directives meet reality
You have the right to include that if you feel very strongly about
that. You can write that down in your
advance directive but the thing is that medical
marijuana isn't legal in the state of Virginia so your doctor's wouldn't be inclined to follow
that instruction. So you can choose to include
it but most likely it would not be followed. So are there any other medications
here any other medications you would prefer be tried first that you want to include?
>>In the past sometimes they've given me Valium
and if I just take a little bit of that it as long as they don't put me on
it too long I feel okay and it helps some okay
>Alright so how about medications that you would not want to be administered
for any reason? >>Thorazine. I really really don't
like Thorazine.I've taken it in the past and I really don't like what it does to me
>So, what are the side effects that you don't like?
It makes me feel like a zombie. I just wonder if I refuse on
the form if I say I don't ever want to take Thorazine does that mean that they can't ever
give it to me? >Well, here is the difference between
medication preferences and refusals. As we were saying before the first
category of medications we were talking about those are medication preferences
Those are what you want to be tried first during a crisis
Those are are not legally binding they're just to guide your treatment and to
inform your doctor about what works best for you
so your treatment goes more efficiently but medication refusals are legally
binding so the only way that if you refuse a medication such
as Thorazine in your case that a doctor could administer it
would be if there's an absolute emergency
you had to be given a medication in that category and
Thorazine was the only one available to them
>>Okay so that means there is a possibility they would give me Thorazine
>There is a possibility but in my experience working with people
Most of them have said that there are usually more than one medications
available to the physicians at the hospital
>Okay Dana so we will kind of get to this next part
and this one is called mental health crisis intervention because it kind
of covers a couple of different areas of information that will give your
doctors or your agent important information
to know about what helps you when you're in crisis,
what doesn't help you when you're in crisis
so they can make good decisions for you
so does that sound do you have any questions?
>>No >Well we'll kind of get started
>We'll work through it like we have the other sections
The first bit here is kind of talking about stuff from the past
what you know about how you are when you're in crisis
so first there are symptoms. It asks about symptoms you might
experience during a period of crisis so things you think or how you
behave maybe people have mentioned stuff to you about how
you seem different when you're in crisis
>>When I'm in a crisis? You mean when I'm not feeling
good? >Yeah
People tell me I well I don't like being around people
when I don't feel good and people tell me I do things with
my hands. I play with my hair and
I just like being at home >Well those are good things to
put down those are kind of good description. You're shying away from people
kind of busy with your hands playing with your hair all that
Is there anything else that you notice about yourself when things are getting
worse and you're not feeling good? >>Well, I definitely don't like
taking my medicine when I don't feel good because I feel like it makes
me feel worse >Well, we can put that down here
too and then people know and that's why you're going to
say no to your medications but they'll kind of know that's a sign actually that they need
to get some help for you. Are there any things that people
can do or that you do for yourself that help you feel better when you're feeling bad like
that? >>Well, the only thing that really
helps me is my dog Baxter >Yeah?
>>Baxter really understands me and he's better than medicine
or a therapist or anything >So, then we can put that down
spending time with Baxter. We'll put down that he's your dog
so people know who he is and they'll know that something
that can help you when you are >>Do you have a dog?
>I don't have a dog but I know a lot of people who have dogs they really
like when they are feeling down they
can be really helpful so we'll put that down and then
they'll know about that and they might be able to help
get a hold of Baxter and >>Well, you know if I'm really bad
then I'll probably be in the hospital and no hospital has ever let
Baxter visit. >You're right about that the hospitals
usually have some sort of rules that don't let animals
that hey don't know on the grounds but a lot of hospitals to have
pet therapy type programs so still having that information
down would you be interested in maybe a temporary dog friend
There might be one that is allowed to come in each week and you could spend some
time visiting maybe so it would still be good information
to have down >>Yeah, if I can't have Baxter
but I don't want a cat >Okay we can make that clear
>>Or ferrets >I wonder if they would have any
ferrets at a hospital. Not sure but we'll put down about
dogs for sure about that that you would be interested in maybe a pet therapy dog
>>Okay >Are there anything so those are
things that are helpful is there anything that makes
it worse for you anything that people try to do when you're not doing
so well? When you're having a bad day or you're in the hospital that actually
makes it worse though >>I hate it when people sound like
Hallmark greeting cards or something you know >>Yeah
>Smile is just a frown turned upside down you know
Look on the bright side of life you know
That's not real that's you know that doesn't help
and on the other side I really
don't like people up in my face and yelling at me and telling
me what to do and that happened to me at a hospital
one time and
and I didn't want to go to group and
they just kept telling me getting in my face telling me I have to go to group
and then I just went off and then
I ended up in the restraint chair and that certainly didn't help
me calm down any so you know so getting up in my
face and yelling at me, telling me what to do I don't like
that you know I'm a grown up and they
don't have to yell at me like a kid. I'm a grown up you can talk to
me like that >Yeah, that makes a lot of sense
not being talked down to like a kid being respected like a grown up
So we'll put all of that down we'll put down about not any of those cheery
Hallmark phrases but also not being pushy and
talking down to you like you're a kid and that will let them know what
sort of tone works best, what's helpful to you when you're in crisis
>>You would think that these people go to school forever
They would kind of know that already but they don't
You know they have all of these letters after their names and everything and
it's like just common sense >It can be frustrating I know
I've definitely worked with people and but people have different
things they like so that's part of what makes this so helpful is
as far as getting it down just so that it's clear as day for them hopefully
>>Okay >Anything else for that section?
>>Well you know I don't really that Hospital
you know it was General Hospital and
you know I went in the restraint chair more than once and I I just don't want
them to do that again >Well then maybe what the next
section will be could be good to talk about that because this next part is actually about
crisis units or hospitals or facilities or places that you
might end up when you're having a crisis so you can put down ones that
you prefer to go to and then we can also put ones that you prefer not to go to.
So, we'll put down General Hospital as one you prefer not to go to
Does that sound good? >>Yeah I definitely don't want
to go there >And then there is sort of even
a spot to explain why so you had a bad experience
Is there anything else you want to kind of explain about why you don't want
to go to General Hospital? >>Well they're mean and they treat
patients like kids and they love their their restraint
chairs I mean they just love them and you know
that doesn't help me at all >Okay so really not a good fit
for you with the restraint chair for sure and then the way they kind of
treated you so we can put that down here as to why
Are there any places that you would like to go
or that you're at least more comfortable about going to if you need it?
>>I went to Sloan Grey once and it was okay
>Okay so is it okay to put that down as a place you would prefer to go to
if needed? >>Well, I went there for my gallbladder
I don't know if they have psychiatric or not but if I had to go back to a hospital
well not for my gallbladder because I don't have it anymore
if for something else I would like to go there
>So maybe before we put it down because this is kind of about help mental
health care it'll be good we'll check out
to see if they have a psych unit before we put it down but maybe
that will be something we can put in that one as a place you prefer to go
Okay so we'll keep that in mind and we have General Hospital
down as a place you prefer not to go >>Does that mean I'll never have
to go back there again? Well this section kind of works
like the last one about medications where there's preferences
which are things that are going to kind of guide the doctors
or the case managers or whoever's helping you get treatment but it doesn't bind
them. The fact is none of us really
have control when there is a bed available at different locations but this
information does at least tell them don't
try General Hospital first. Try some other places first and
make that a last resort kind of option so you know there's the possibility
that there wouldn't be a bed anywhere else but at least they won't try General
Hospital until that's the only option left >>Okay
>Okay So now in this last bit
Sorry there's one more bit here about what staff can do to help you when when
you're in crisis. We talked about things that are
not helpful. Is there anything in particular
that they can do that are helpful when you're having a bad day?
>>Leave me alone just leave me alone
and if they let me go to my room or go outside that's good
I like music but they won't let me have my iPod
if I could have my iPod then I could listen to my music and that really
helps and I love crossword puzzles but
most of them don't have crossword puzzles around
They just have a old magazines. >It's still good details to put
down though because if they do then they can make them available for you
or maybe if you do end up somewhere where you're allowed to have your iPod
for some time each day or something like that then they know
and they can bring it so we'll put it down about being left alone
and either going to your room or being outside
having time to yourself and then music and crosswords
>>Okay >And so now this last section
is about behavioral emergency interventions, so that includes things like
medications in pill or liquid form or injections
but also things like restraint or seclusion
and this is sort of when things are really bad in crisis in a crisis moment
and the section has a listed here so that you can
kind of rank them in order of 1 to 4
and that's to kind of say which one if they had to happen
which one would you prefer over another
>>Well I don't want any of that and
I won't get in the crisis if they just you know leave me alone and stay out
of my face you know
That's the only time that I go off
>Okay so hopefully with some of the information
we put down that will help make that not even happen
but the thing is and you don't have to feel this section out
just like other any of the other sections
but it's one of those that it's kind of good to think about
filling out because a lot of hospitals you know have some sort of procedure
in place for crises and emergencies and so they might they are set up to do one
of these things so hopefully it doesn't happen
but if it did it's kind of nice to be able to have that information for them
>>You know if they offered me medication and
said it might help close call me down
then I would probably take it but they don't
you know they say you know you have to take this
and if you don't we're going to to stick it up your butt or
we're going to put your in the restraint chair and then that doesn't work
then I just like you know whatever > Okay so what we'll do is for this
one that says medication in pill or liquid form we can put that as one
and we can kind of even include a little bit that says if it's offered as
something to help calm down instead of forced on me
>>Yeah [>Okay
and we can make it more specific like that
What about some of the others I know you mentioned that at General Hospital
you were in the restraint chairna lot and that was not a good fit for you it
didn't sound like so would that maybe be sort of
the last resort if you had to number them in order
>>Oh yeah but I don't like the shot either
but I guess restraint is worse than the shot
>Okay and you don't even have to do all one, two, three and four
if you don't want if you just wanted to do clearly one and clearly four
>>What is seclusion? >Seclusion in when they kind of
put you in a room alone and it's usually the door is locked or something though
>>Oh no no no no no. I don't want that I'll go to
my room and be by myself and calm down but I don't want the door locked.
>Okay so we can kind of put that down as something that would be okay
with the specific instruction of if I'm allowed to be in my room with the
door unlocked, not a locked door kind of situation >Yeah I don't like the door locked
so we can kind of make that a little more clear so that we can say
Seclusion would be okay in the sense of time alone in my room
>>Okay >And there's this space here and
We can always add more about why you put them in the order that you did
that is where we will get all those details down so they understand why
you put them in the order you did. There's also a spot here that
you can kind of check off about having had a about having had a traumatic experience
in the past and that's why it's really stressful
and not a good fit at all for you to be in one of these sort of situations
so I'm wondering would it be important to check that off for you?
>> Well I don't like seclusion because my mom used to lock me in my bedroom when
I was bad and I was bad a lot
and I don't like to hear the door lock
and General Hospital when they put me in restraint it was really awful I
don't ever want to do that again. >Okay so we can check that off
and that will give them a heads up that there's some really important reasons
why it's not just that you don't like it
but it's there some really stressful and inappropriate sort of things that happened
for you if you're put in those situations
and that will hopefully help them to make sure they don't use that unless it's absolutely
necessary. >>Okay.
>Okay
>Okay great Heather the next section
it's just talking about sort of general health care instructions
besides the mental health care instructions
The first question is really broad its in general do you have any other
healthcare situations or conditions or allergies some
people have some food preferences that really impact them
>>Yeah, I'm allergic to bee stings >Okay I'll put that in there I
think we put that in there earlier but it's good to have it here
too >>And then I have a condition I
take something for it every day. It has to do with my thyroid.
>Oh okay
>>I can't remember what it's called
>I'm going to write down just thyroid
>> Okay > And elsewhere in the medication
piece I think you put down your thyroid medication >>Yes
>So I'll make sure they're aware of the thyroid piece too
Anything else just general medical information
people need to know about if you are in a situation where
you're unable to take care of your medical needs
yourself is there anything else people need to know?
>>Can I put down about a hospital that I like before only for medical hospital
>Sure >>Because I went to one one time
for something and they were really nice there
so if I could go there if I needed to go to a hospital
I'd like to go there again. >Great, which hospital was that?
>>Sloan Grey.
>Can you tell me what was good
about that hospital? >>They were just really nice
The nurses and everybody they talked to me
and they told me what was going on which made me feel better because I didn't
know what was going on and that was scary so I just
thought that they did a good job of talking with me
instead of just telling me to do this or do that
>You know I don't think we touched on that earlier
Let's put down here that things that help you are people that tell you what's
going on. >>Yeah
>So you have some insight into what's happening
>>Okay that would be helpful yeah >Great sounds good
>>Thanks. >Anything else in the general
health care instructions? >>I don't think so
>Okay. The next piece is visitation
You get to decide who can come visit you when you're in the hospital and
who can't and some ways this is a good
piece because there may be people who
[like my agent doesn't like my best friend
so I want to make sure my best friend is allowed to come
so this might be a good place to put down things like that
>>I want to put down my best friend too
>Does your best friend have a name? >>It's Claire Jones
She's great. I want her around when I'm if
I'm not doing good and then
I should probably put down my girlfriend too
That's Samantha Hotchkins. >I think that's an important one
too. Anyone else see when I give permission
to, specifically give permission to? >>Should I tell you like all of my
cousins names? I have a lot of cousins and they
could all visit me and that would be fun my aunts and
my uncles >We could just get like a phone
book and put it in. It might be more appropriate
to just list the people that people
might not think of or that it might be kind of controversial to have them there
>>Okay, then probably my friend and my
girlfriend covers it those would be the ones that I want to make sure
>And the second question is you don't give permission to certain people
There may be somebody you don't want to have there
>>One of my cousins actually I don't want him to be there because he doesn't like
my girlfriend and and is a real jerk so I don't
want him to be in the hospital > It would be a stressful to have
someone visit you when they're a jerk >>So, I really don't want Terry
to be there. >Great, how do you spell Terry?
>>T E R R Y >What's his last name?
>>Hughes H U G H E S
>Okay, is there anyone else you don't
want to visit you? >>No, I get along with everybody
else besides Terry. >Okay great
I know when I was in the hospital, it's been awhile since I've been
there thank goodness, but when I was in the hospital
someone came and they brought flowers. They were so nice they were
from my church and I was so annoyed and irritated
by the whole thing but they thought they were being
nice so I actually put in mine that
I don't want anybody for my church to visit because it was just too stressful
for me there might be a category of people or
>>I didn't really think about that I was just thinking of family
I guess I wouldn't no I wouldn't want people from
work coming by. I mean it would be nice but I
would be embarrassed and stuff and I don't want them to come
when I'm in the hospital. >Alright, let's put that people
from your job. Where do you work?
>>I work at the ABC packaging company >Alright
Cool, so the next question is about
ECT or electroconvulsive therapy. Do you know what that is?
>>I think so. >Yeah some people call it shock
therapy. >>Yeah, that's what I was thinking of
>So you get two options here in
your advance directive: one is that you don't consent
to ever no matter what or that you authorize your agent
to make that decision for you at the time. >>Do I have to get it?
>You don't have to get it. You can say you never want it
or you can give that authorization to your agent who you know
its like usually a second or third line treatment if other things aren't
working and your agent might say I really
want to try this even if you authorize your agent
[during the time your advance directive is active
if you change your mind you're allowed to say no I changed my mind
I don't want it then they won't be able to give it to you.
>> Snd then that doesn't mean my agent�
>>Would my my agent talk to my doctor or would my agent just decide?
>Iif you choose that option then I think you and your agent need to have a
really good heart to heart talk about what ECT means to you and
what kind of treatments are helpful to you and what any concerns or fears
you might have about it and then if you check that
should you be in the hospital and the situation arises
that it's one of the treatment options presented to your agent if you check
this your agent then has to decide yes or no
>>Okay. I mean it looks scary but I know
they've talked about it for me before and I didn't have it
but it sounded like it might be something that I shouldn't say no to
so I'm going authorize my agent and then I'll talk to her about it
>Okay. I heard one thing in what you
just said I shouldn't say no and I want to make sure that's a shouldn't
from within you. Its like oh yeah I think that's
probably a good idea I don't want to say no and not a shouldn't that somebody
else is putting down on you. You shouldn't say no to that
I just heard that in your language
>>Yeah no. When they told me about it before
and they said if things got bad enough it might work for me
and so it would be something that I could consider
and think about and so I don't want to say no
I don't want to say no no no and not consent
so I'd rather leave that open for my agent to decide
>That sounds great. We're moving right through here
We're just about done. So the next section is just
on general life management instructions like some things that come up
are when you're going to be away
from home for a while sometimes it's nice to have someone
taking your mail so it doesn't look like you're gone
or you might have a dog or plants that need to be watered or the dog need to
be watered or walked. Maybe he can go to someone else's
house I don't know. Lots of things that you might
want to have just taken care of for you while you're
away. Some of those questions have
already come up if you've done a WRAP in your WRAP crisis plan.
Have you done a Wrap? >>I did yeah I did I answered all
those questions about that kind of stuff before. >Great, do you have a copy of that?
You don't have to have it with you but do you have a copy of that somewhere?
>>Yeah >Good yeah before we finish all
this all up let's make sure you get your
copy of your crisis plan and we'll just attached this
at the end and I'll put see attachment A WRAP crisis plan right here
>>Great yeah it's got a lot of information in it
>That's actually really good to have it as an attachment
because then you can make some changes to it if you want to it without having
to change this whole thing. >>Okay good
>Yeah >>Good great
>Hi Jane >>Hi
>So we're almost there we're almost done
but we're going to talk right now about
what sort of care or treatment you want or don't want if you're at that point
in your life and a lot of us don't like to
think about or talk about but you're at the end of your
life so either you have an injury
or an illness and there's no cure
The doctors aren't going to be able to fix it
and you might have heard this as a living will it's what it's called in
Virginia, where can say whether you
would want extraordinary care. Things like a respirator to keep
you breathing, a feeding tube
if you can't take food and liquids by mouth anymore,
if you'd want those things to keep you alive for as long as possible
or if you're at the end of your life and you would rather not prolong it
and just kind of let nature take its course and
not have those things. Is this something that you've
ever thought about or experienced with a family member or?
[>>Well yeah I thought I really don't want to have any
of that stuff. I try to live naturally
Eat natural foods so that would go right along with my wishes would be not
to have any of those things done to me
>Okay, so you wouldn't want any treatments
to prolong your life any further? >>No
>Then we can put that down as your choice for that
>>Is this the same thing as a DNR? >You can put on here that you
don't want CPR to restart your heart that's that thing they do to
restart your heart once it stops but if you really truly want
a DNR like if you're in the hospital
and your heart stops and they don't start it again by any means
then you need to talk to your doctor
and your doctor can actually write an order
it has to be written on specific form
and it has to be signed by your doctor
so you can put your preference here or if you wanted to be absolutely followed
legally then you'd have to take that
extra step and talk to your doctor. >>Okay
>to get that do not resuscitate order
>>Okay >So the other part of this section
talks about and it's very similar
to what we just talked about but it has to do with
you're not at the end of your life
you don't have a terminal illness but
if you get injured somehow and you're in like a permanent coma
what they call a persistent vegetative state
I don't know if you've ever heard of that like Terri Schiavo
was in the news a few years ago, if you would have the same options
that you had before, whether you want them to prolong
your life with the extraordinary measures or or not
but there's one other option which is to try those things for a certain
period of time to either see if there's any
improvement or like for me I have family in
California so I said it's okay to try it for a week or two
even if I'm not going to survive my family has time to get to
the hospital and say their goodbyes. >>I hadn't thought of that that's
a good idea to let people get there because
I know when one of my friends was dying there was relatives out of town
and it was good that he was on
the life-support stuff for a while so his relatives could get there
>So is that something that you might want to put in your advance directive?
>>I really have to think about it this is a scary thought to think
I might go out of here and maybe get hit by a bus or something and be like
that like right now I wouldn't
I wouldn't want them to give up on me right away
>Sure >>But I also don't like to be like
the thought of being hooked up to machines so
I really I think I have to think about that a little bit
>So you can think about whether you'd want the option of trying for certain
period of time and then if you do think about
how long do you think that period of time should be
to either give it a try or to give relatives time to get here
and then after that period of time say
remove those things and let me go
so you're right it's something that you definitely want to think about and
it's not an easy decision that's nothing we want to think about all.
Do you have any questions about that at all?
>>No I think I understand >Okay
>Okay Jane so we've made it just about the entire way through
and we're down to the last section here
and it's just about anatomical gifts so that's donating organs and things
like that and this section kind of lets
you give some instructions to your agent or whomever
about what you would like to donate and you have a couple different options.
So did you have any interest in donating organs after you pass?
>>Well I'm interested in donating some things but I'm not real sure exactly
what it means to donate like my organs or my eyes or
my tissues or donating my whole body. I mean what does that mean?
>Yeah it's kind of weird to think about
and kind of weird to think about it happening afterwards but
this kind of the first one; there's sort of two boxes and
the first one talks about organs, eyes, tissues and then it list for because
it can be used for different things for so lot of times we think of about transplantation
so if somebody gets a donor organ that helps them
or therapy but also sometimes they're used
for research and education and so the thing with this list
is like with other places if you kind of say well okay
>>I feel okay about donating my organs because maybe somebody needs
a kidney and I think mine are pretty good but I don't know about my eyes
or other tissues. >Tissues would be like skin or
something like that. You can cross those out and just
leave the ones that you're comfortable with and then the same thing for if
you only really want it used for transplant or something like that
or if you're kind of like no I don't want my organs used for research you
can cross those out. You can kind of tailor it just
like the other sections if there's something you're kind
of not too sure about. Donating your whole body is sort
of like medical students or researchers will sometimes use whole bodies
because it helps them. They are still discovering things
and teaching about how the body works and stuff
so that would be generally speaking I don't know the specifics but kind of what
it would be about. >>Okay
>>Yeah I guess I would donate some of my body parts for transplant but
that kind of weirds me out to think about people taking my body
and studying it after I'm dead. It's gross
>Yeah different people some people are all for it and
some aren't but that's great. So what we can do is we'll just
check off the box that's about organs and just organs or eyes and tissues
too? >>Yeah for transplant
>So then we'll cross out the research and education part but we'll leave the transplantation
and the therapy I think is sort of like that medical use kind of thing
as well so that'd be okay?
>>Okay. >Great so then if there's anything
specific maybe there's an organ that you
think just wouldn't be good to have transplanted we can kind of put down any specific
instructions here or... >> No I think I would be okay
>Alright then I think that takes care of that section
so we're ready to get it all signed and
then we'll have it all ready for you
>>Alright
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