Rights and Choices
People have certain rights regarding access to information related to their medical conditions and the
ability to make their own medical decisions. Various choices are available to individuals to help guide
the care they receive at the end of life.
Patients’ rights are protected under state laws which that guarantee that every patient has the right to be
informed about his or her medical condition and prognosis, the risks and benefits associated with a
procedure or course of treatment, and any treatment alternatives that exist.
Patient Self-Determination Act
Enacted into federal law in 1990, the Patient Self-Determination Act requires facilities that receive
Medicare and/or Medicaid funding to provide patients with a statement of their rights concerning
advance directives, to ask whether they have advance directives, and to place patients’ advance
directives in their medical charts.
In the Cruzan case, the Supreme Court found that a competent person has a constitutionally protected
liberty interest in refusing unwanted medical treatment. The Court also found, however, that states can
require clear and convincing evidence of individuals’ health care wishes.
Advance directives are:
documents that provide instructions concerning an individual’s health care preferences
(instruction directives); and
documents that appoint proxies to speak for individuals who are unable to speak for
themselves (proxy directives).
Putting health care instructions into writing is considered by the medical community and the courts to be
the most reliable evidence of an individual’s wishes. Advance directives also help to avoid disputes
among family members, protect the privacy of these very personal decisions, and give guidance in
situations in which emergency medical treatment is required.
Each state has its own law concerning advance directives. Connecticut law recognizes a number of
options through which individuals can express their wishes. These are described below.
A living will is a document that expresses an individual’s wishes concerning life support and any other
In Connecticut, life support includes CPR, mechanical ventilation, and artificial
means of providing nutrition and hydration. These are described in more detail later in this booklet. A
living will only becomes operative if 1) an individual has a terminal condition or is permanently
unconscious; and 2) a doctor finds that he or she is unable to understand and communicate an informed
decision about treatment. A living will can be used to indicate that an individual wants to refuse certain
treatments. It can also be used to indicate that an individual wishes to receive certain treatments.
Appointment of Health Care Representative
In situations in which an individual is unable to speak for him or herself, an appointment of health care
representative authorizes another person to accept or refuse any treatment, service or procedure used to
diagnose or treat a physical or mental condition, including withholding or withdrawing life support.
This advance directive replaces the older appointment of health care agent and durable power of
attorney for health care decisions forms. Please note, however, that if an individual completed one of
those forms prior to October 1, 2006, it remains valid.
Advance Designation of Conservator
An advance designation of conservator is a document through which an individual can indicate whom he
or she would wish to have serve as conservator if a probate court later determines that the individual is
legally incapable of making decisions and the court finds it necessary to appoint a conservator.
Document of Anatomical Gift
A document of anatomical gift authorizes donation of all or part of an individual’s body upon or after
Designation of Disposition of Remains
A designation of disposition of remains is a document through which an individual can indicate his or
her wishes concerning custody of his or her body, as well as wishes concerning burial, cremation and/or