Medical Care Decisions
Know Your Options
If you would like more information on advance directives, please speak with your nurse or call VitaLine at 910-815-5188.
When a medical crisis occurs, you may find yourself overwhelmed and unable to fully process what is happening. Sometimes you may be asked to make medical and treatment decisions for a loved one. Many people find peace of mind knowing that if they are faced with this situation, they have a plan in place to communicate their wishes or to understand the wishes of their loved one. Advance directives are legal documents that allow you to express your medical care decisions ahead of time if you are unable to communicate for yourself.
What Are Advance Directives?
This legal document outlines what your healthcare choices are if you are unable to speak for yourself. Advance directives come in two main forms:
- Healthcare power of attorney (or "proxy" or "agent" or "surrogate"), which documents the person you select to be your voice for your healthcare decisions if you cannot speak for yourself
- Living will, which documents what kinds of medical treatments you would or would not want at the end of life
What are my rights? Who decides about my medical care or treatment?
If you are 18 or older and have the capacity to make and communicate healthcare decisions, you have the right to make decisions about your medical/mental health treatment. You should talk to you doctor or other healthcare provider about any treatment or procedure so that you understand what will be done and why. You have the right to say yes or no to treatments recommended by your doctor or mental health provider. If you want to control decisions about your health/mental health care even if you become unable to make or to express them yourself, you will need an "advance directive."
Do I have to have an advance directive and what happens if I don't?
Making a living will, a health care power of attorney or an advance instruction for mental health treatment is your choice. If you become unable to make your own decisions; and you have no living will, advance instruction for mental health treatment, or a person named to make medical/mental health decisions for you ("healthcare agent"), your doctor or health/mental healthcare provider will consult with someone close to you about your care.
If you would like more information or assistance in initiating an advance directive, we can assist you. Please ask your nurse to contact the social worker.
When Difficult Decisions Need to be Made
If you find yourself having to make a difficult medical decision, you are not alone. Our Ethics Committee can talk through your options with you and help you reach a decision you are comfortable with. The Ethics Committee includes specially trained physicians, nurses, other healthcare professionals, clergy, community members and a medical ethicist. They are available to listen to your situation objectively and help you work through the decision process.
To get in touch with the committee, speak with your nurse or call VitaLine at 910-815-5188.
In North Carolina, a living will is a document that tells others that you want to die a natural death if you are terminally ill and incurably sick or in a persistent vegetative state from which you will not recover. In a living will, you can direct your doctor not to use heroic treatments that would delay your dying, for example by using a breathing machine (respirator or ventilator), or to stop such treatments if they have been started. You can also direct your doctor not to begin or to stop giving you food and water through a tube ("artificial nutrition or hydration").
In North Carolina, you can name a person to make medical/mental healthcare decisions for you if you later become unable to decide yourself. This person is called your "healthcare agent." In the legal document you name who you want your agent to be. You can say what medical treatments/mental health treatments you would want and what you would not want. Your healthcare agent then knows what choices you would make.
You should choose an adult you trust, discuss your wishes with the person and then put those wishes in writing.
How do I make an advance directive?
You must follow several rules when you make a formal living will, health care power of attorney or an advance instruction for mental health treatment. These rules are to protect you and ensure that your wishes are clear to the doctor or other provider who may be asked to carry them out. A living will, a health care power of attorney and an advance instruction for mental health treatment must be written and signed by you while you are still able to understand your condition and treatment choices and to make those choices known. Two qualified people must witness all three types of advance directives. The living will and the health care power of attorney also must be notarized.
Are there forms I can use to make an advance directive?
Yes. There are advance directive forms you can use that meet all of the rules for a formal advance directive. Using the special form is the best way to make sure that your wishes are carried out.
When does an advance directive go into effect?
A living will goes into effect when you cannot be cured and death is imminent, or when you are in a persistent vegetative state. The powers granted to your healthcare power of attorney go into effect when your doctor states in writing that you are not able to make or to make known your healthcare choices. When you make a healthcare power of attorney, you can name the doctor or mental health provider you would want to make this decision. An advance instruction for mental health treatment goes into effect when it is given to your doctor or mental health provider. The doctor will follow the instructions you have put in the document, except in certain situations, after the doctor determines that you are not able to make and to make known your choices about mental health treatment. After a doctor determines this, your healthcare power of attorney may make treatment decisions for you.
What happens if I change my mind?
You can cancel your living will anytime by informing your doctor that you want to cancel it and by destroying all copies. You can change your healthcare power of attorney while you are able to make and make known your decisions, by signing another one and telling your doctor and each health care agent you named of the change. You can cancel your advance instruction for mental health treatment while you are able to make and make known your decisions by telling your doctor or other provider you want to cancel it.
Whom should I talk to about an advance directive?
You should talk to those closest to you about an advance directive and your feelings about the health care you would like to receive. Your doctor or healthcare provider can answer medical questions. A lawyer can answer questions about the law. Some people also discuss the decision with clergy or other trusted advisers.
Where should I keep my advance directive?
Keep a copy in a safe place where your family members can get it. Give copies to your family, your doctor or other health/mental healthcare provider, your healthcare agent, and any close friends who might be asked about your care should you become unable to make decisions.
What if I have an advance directive from another state?
An advance directive from another state may not meet all of North Carolina's rules. To be sure about this, you may want to also make an advance directive in North Carolina. Or, have your lawyer review the advance directive from the other state.
The following links can help you learn more about advance directives and advance care planning.