Oklahoma Kidney Stone Center

Policy Statement Regarding Patient’s Right to Self-Determination

  • To the extent allowed by law, it is our policy to follow the directions with respect to medical care at Oklahoma Kidney Stone Center of our patients who have the capacity to make decisions. You will be considered to have capacity to make health care decisions unless unconscious, determined to be incompetent by a court of law or medically determined by your attending physician to be unable to make health care decisions.
  • Before any non-emergency medical treatment is performed, you have a right to receive from your physician whatever information you need to give your informed consent. The information provided to you should answer your questions about the intended procedure or treatment, the potential risks associated with the treatment, alternative treatments and their risks. You will be asked to sign a form verifying you have given your physician your consent to perform the procedure.
  • If you refuse treatment, you will be informed by your physician of significant medical consequences that may result and may be asked to sign a form about your refusal.
  • If you are unable to make decisions, but have signed a valid advance directive, we will follow your directive to the extent allowed under Oklahoma law. No life-sustaining treatment may be removed during pregnancy.
  • If you are unable to take sufficient food and water by mouth to keep you alive and are without capacity to make health care decisions, Oklahoma law considers that you have directed that tube feedings be administered, unless:
    1. You have an advance directive specifying the withholding or withdrawal of tube feedings and you are in a condition defined in your directive;
    2. Your physician clearly knows or a court finds that when competent and with information necessary to make such a decision, you decided that tube feedings should be withheld or withdrawn;
    3. The tube feedings themselves would cause you severe, intractable and long-lasting pain;
    4. Tube feedings are not medically possible; or
    5. You are chronically and irreversibly incompetent and in the final stages of a terminal illness or injury in which death is imminent and death will not be caused by dehydration or starvation.
  • Similarly, if you are without capacity to make health care decisions, you will be considered to have directed other life sustaining treatments be given, unless:
    1. You have a valid advance directive and are determined to be in a condition which qualifies you to have treatment withheld; or
    2. The treatments are considered medically inappropriate or futile; or
    3. All family members agree that the proposed treatment is not what you would want and your family members have signed a Family Verification to that effect.

If you have questions regarding our policies, please talk to your physician or nurse.

Please complete, sign and bring this form with you:
Do you have a directive to physicians or living will? Yes No
Do you have a medical durable power of attorney? Yes No
Do you have a legal guardian? Yes No
Please provide name
I have received a copy of the State notice and this ASC policy statement on the day of , 20