MY ADVANCE CARE PLANNING GUIDE
For North Carolina
TALK! et’s and L r values l us you hcare. Tel ur healt bout yo beliefs a on onversati ave the c . time to h ur family Take n and yo r physicia with you honest. open and Always be our t about y no doub Leave nces. d prefere values an
Keep your documents up do date and available.
We want to know To complete an Advance Care Plan: your wishes Go to www.sentara.com/advancedirectives Call Sentara Albemarle Medical Center (252) 384-4125 or the Sentara Center for so we can Healthcare Ethics at (757) 252-9550 or honor them. 1-800-Sentara (736-8272) Ask your physician or healthcare provider Table of Contents
Have the TALK – Protect your rights to control healthcare decisions...... 1
Important Conversations ...... 2
Terms You May Need to Know...... 3
What Powers am I Giving to my Healthcare Agent?...... 6
Questions and Answers ...... 7 Have the TALK! Protect Your Right to Control Your Healthcare Decisions
Healthcare is vitally important to everyone. Wherever you are, whatever the situation, you want to be sure you receive excellent medical treatment. But even more importantly, you want your medical choices to be understood and honored.
The law guarantees your right to If you plan now, in advance, you can make make those decision about your medical sure your wishes are known, and that you care, even when you are too sick or get the kind of care you want and relieve injured to make your wishes known. your family of having to make difficult These “rights” give you control over your and stressful choices. You decide, in choices at a critical advance, in writing, time in your life. You what your healthcare can choose to accept choices are if you cannot speak for or refuse any medical “Having Mom’s Advance yourself, and you can treatment that is offered Care Plan made things so specifically direct the by your physicians. Your kind of medical treat- physicians will assist much easier at a difficult time. ment you do or do not you by informing you of Now I am doing the same for want if, e.g. you become the risks of the medical terminally ill, or have a permanent and severe interventions, the my own family.” brain injury with no hope benefits you might of improvement or expect and possible recovery. You can let alternatives. But, how your family, friends, can you be sure that your choices will be doctors, and healthcare providers know honored if you are unable to speak for your treatment wishes through your yourself? Advance Care Plan.
1 Important Conversations about Your Healthcare Choices
$Q$GYDQFH&DUH3ODQPD\VKDSHKRZ\RXH[SHULHQFHDSHULRGRIGLVDELOLW\RUWKHYHU\ILQDO VWDJHRI\RXUOLIH +RZ GR \RX HQVXUH WKDW \RXU IDPLO\ NQRZV ZKDW \RXU EHOLHIV DQG YDOXHV DUH DURXQG \RXU PHGLFDOFDUH"2QHZD\WRGRWKLVLVE\GHYHORSLQJ\RXURZQ³YDOXHVKLVWRU\´DQGKDYHDFOHDU XQGHUVWDQGLQJ RI \RXU KHDOWK )RU H[DPSOH \RX FRXOG GLVFXVV \RXU YDOXHV DQG ZLVKHV ZLWK ORYHGRQHVRUDGYLVRUVRUZULWHGRZQ\RXUUHVSRQVHVWRTXHVWLRQVVXFKDV s :KDW GR , NQRZ DQG IHHO DERXW P\ s +RZGRP\SHUVRQDOUHODWLRQVKLSVDIIHFW KHDOWKVLWXDWLRQWRGD\" PHGLFDOGHFLVLRQPDNLQJ" s :KDW FRPSOLFDWLRQV PLJKW , s :KDW UROH GR , ZLVK P\ SK\VLFLDQV DQG H[SHULHQFH IURP P\ FXUUHQW KHDOWK RWKHUV WR SOD\ LQ PHGLFDO GHFLVLRQ FRQGLWLRQ" PDNLQJ" s ,VLWLPSRUWDQWIRUPHWREHLQGHSHQ s :KDW NLQG RI OLYLQJ HQYLURQPHQW LV GHQWDQGVHOIVXIILFLHQWLQP\OLIH" LPSRUWDQWWRPH" s :KDWDUHP\WKRXJKWVDERXWLOOQHVV s :KDWUROHGRUHOLJLRXVVSLULWXDOHWKQLFRU GLVDELOLW\G\LQJDQGGHDWK" FXOWXUDOEHOLHIVSOD\LQP\OLIH" s +RZGR,IHHODERXWGRQDWLQJP\RU s :KDW DUH P\ WKRXJKWV DERXW OLIH LQ JDQV" JHQHUDO WKDW LV P\ KRSHV DQG IHDUV HQMR\PHQWVDQGVRUURZV" t +RZGR,IHHODERXWJLYLQJP\ERG\ DVDQDQDWRPLFDOJLIWIRUUHVHDUFK" $GYDQFH&DUH3ODQs (North Carolina - Advance Directive for a "Natural Death" and Health Care Power of Attorney) are available from any staff member orthey can also be downloaded at 2 www.sentara.com/advancedirectives ~ 6(17$5$ Terms You May Need to Know The following terms are referred to in this booklet. We hope this list will help you understand some of the terms and what they may mean for you as you make healthcare choices for your future. Advance Care Planning: Facility A process of decision-making done in advance of Do Not Resuscitate Order (DNR): an illness or injury to plan with your family, In a hospital or other healthcare facility, DNR is a physicians, or spiritual leader what choices you physician’s order to withhold CPR from you in the would make if you became unable to communicate event of cardiac or respiratory arrest. An those choices for yourself. Sometimes the TALK Advance Care Plan does not automatically is done with a trained Advance Care Planning become a DNR order. This must be discussed Facilitator. with, and implemented by your physician. Advance Care Plan: Portable An Advance Care Plan is a term that includes Do Not Resuscitate Order (DNR): A written Advance Directive for a Natural Death as well as physician’s order to withhold CPR in the event of a Health Care Power of Attorney. While the cardiac or respiratory arrest that can travel with the content may be the same or similar, the main patient. This document must be on the State difference is an Advance Care Plan puts more approved DNR form, or MOST form (Medical Order emphasis on TALKing with family, physicians and for Scope of Treatment), to be honored by spiritual advisors about your wishes. Emergency Medical Services. Cardiopulmonary Resuscitation (CPR): Healthcare Agent: CPR involves chest compressions, medications, An adult appointed by you to make healthcare electric shock, and a breathing tube connected to decisions for you. This person speaks for you only a mechanical ventilator. The risks and benefits of when you can no longer speak for yourself. If you this treatment should be discussed with your have made your wishes known through a Advance physician with any change in your health or when Care Plan or have personally discussed your wishes you have a serious or life-limiting illness. with your healthcare agent, he or she is bound by Declarant/Principal law to make decisions in accordance with your A declarant is another word for the individual wishes. If they do not know your wishes, they will signing the Advance Directive for a Natural Death. make decisions they believe are in your best A principal is another word for the individual interest and that you would have made for yourself. appointing healthcare agent(s) pursuant to a Healthcare Power of Attorney. Because the This agent may also be identified as a Medical declarant and principal are the same person, often Power of Attorney or Healthcare Proxy depending these terms are used interchangeably. on the source of the document. 3 Life-Prolonging Procedure: MOST (Medical Order for Scope of Treatment): Any medical procedure, treatment or A written physician’s order which includes orders to intervention which: (i) uses mechanical or provide or to withhold CPR in the event of cardiac or other artificial means to support and prolong respiratory arrest, but also may include orders for other treatment options. Like the DNR, your life if you have no reasonable Portable this form travels with the patient. expectation of recovery from a terminal condition; and (ii) when applied to you in a Surrogate Decision-Maker: Individual(s) terminal condition, would serve only to designated by law to make healthcare decisions prolong the dying process. The term on your behalf, when you are unable to make includes artificially administered hydration decisions for yourself, if you have not named a and nutrition. Life-prolonging procedures do Healthcare Agent or Medical Power of Attorney. not include giving you medication or In order of priority, pursuant to N.C. Code performing any medical procedure §90-322 those persons are: necessary to provide you with comfort care 1. or to alleviate your pain. A guardian of the patient's person, or a general guardian with powers over the Living Will: patient's person, appointed by a court, provided that, if the patient has a health Often thought of as medical instructions care agent appointed pursuant to a valid only for end of life, a Living Will can actually health care power of attorney, the health capture health care preferences or your care agent shall have the right to exercise beliefs and values for any healthcare crisis. the authority to the extent granted in the health care power of attorney. This 'plan' is now incorporated in Advance Care Plans and is part of the larger process. 2. A health care agent appointed pursuant to a The terms Living Will, Advance Directive valid health care power of attorney and Advance Care Plan are often used in 3. Attorney-in-Fact appointed by patient. the same way. 4. The patient’s legal spouse. Organ and Tissue Donation: Donation 5. Majority of reasonably available parents and of your organs (such as heart, lungs, liver or adult children of the patient. kidneys) or other parts of the body (such as eyes, skin and bone) after death. 6. Majority of reasonably available adult brothers/sisters of the patient. 7. Persistent Vegetative State: An individual who has an established An incurable and irreversible condition, relationship with the patient, who is acting in caused by injury, disease or illness, that good faith on behalf of the patient, and who causes a loss of consciousness with no can reliably convey the patient's wishes. behavioral evidence of self-awareness or awareness of your surroundings and from Terminal Condition: which, to a reasonable degree of medical An advanced, irreversible condition caused by injury or probability, there can be no recovery. Your illness that has no cure and from which doctors expect eyes may open and your body may move, the person to die, even with maximum medical treatment. but it is without any self-awareness or Life-sustaining treatments will not improve the person’s conscious thought. condition and will only prolong the dying process. 4 Witness/Notary: A person who will verify your signature on an Advance Care Plan. The North Carolina Advance Directive for a Natural Death and Medical Power of Attorney must be witnessed by two people over 18 years of age, along with a Notary. All witnesses must comply with the following: s Any witnesses must not be related by blood or marriage to the declarant. s Should not have any reasonable expectation that they would be entitled to any portion of the estate of the declarant upon the declarant's death under any will or codicil of the declarant then existing, or pursuant to the Intestate Succession Act. s May not be the attending physician, a licensed health care provider that is a paid employee of the attending physician, a paid employee of a health facility in which the declarant is a patient, or an employee of a nursing home or any adult care home in which the declarant resides. s May not have a claim against the declarant or the estate of the declarant at the time of the declaration. s The document must be proved before a clerk of court or a notary public. 5 What Powers am I Giving to my Healthcare Agent? Once it has been determined by your attending physician that you no longer are able to speak for yourself, your Healthcare Agent has the power to (or as authorized/limited in your Advance Care Planning documents: • Request, receive, and review any • Giving consent for, withdrawing consent information, regarding physical or for, or withholding consent for, X-ray, mental health, including, but not anesthesia, medication, surgery, and all limited to, medical and hospital other diagnostic and treatment records, and to consent to the procedures ordered by or under the disclosure of this information. authorization of a licensed physician, dentist, podiatrist, or other health care • Employ and discharge healthcare provider. This authorization specifically providers; includes the power to consent to measures for relief of pain. • Consent to and authorize admission Authorizing the withholding or withdrawal to and discharge from a hospital, • nursing or convalescent home, of life-prolonging measures. hospice, long-term care facility, or other health care facility. • Consent to and authorize admission to and retention in a facility for the care or treatment of mental illness. • Consent to and authorize the administration of medications for mental health treatment and • Other provisions or limitations may electroconvulsive treatment (ECT) apply. For a complete listing, please see North Carolina Code Section 32A - commonly referred to as "shock 15 et. seq. treatment." 6 Questions and Answers about Your Healthcare Rights What if I change my mind? If I write an Advance Care Plan, will I still Q Q receive medical treatment? You can revoke or modify your Advance Care Planning documents at any time. Yes. Your Advance Care Plan includes A This is your plan and it should change as the kind of medical treatments you DO or your health changes. A DO NOT want. Even if you choose not to receive life-prolonging treatment when you have a terminal condition, many medical Can I get my physician to witness treatments can still be provided to manage my signature on my Advance Care your symptoms, relieve pain, and provide Q Planning documents? support to you and your family. NO. North Carolina law does not allow your physician to be a witness on your Advance Care Planning documents. Please see the A Witness/Notary section on page 5 for a more detailed list of who may act as a witness. I created an Advance Directive for a Natural Death several years ago. Is it Q still in effect? Do I have to use the form that is Yes. Advance Directives are valid until Q provided by North Carolina? A they are revoked. Keep reading to find out how you make changes or revoke No. There are a variety of forms that are your document. However it is important to available, and attorneys often include an review your document at least once a year Advance Directive for a Natural Death and/or or anytime you experience a change in A a Healthcare Power of Attorney in other your healthcare. estate planning documents. Provided that these documents are consistent with the relevant North Carolina Code provisions, there is no particular form that is required. 7 What happens if I cannot make my own What about emergency situations? Q healthcare decisions? Q Advance Care Plans are not designed for First, your physician must determine that A emergency situations, so Emergency Medical A you lack capacity to make or Service (EMS) personnel can not follow an Advance communicate your healthcare wishes. If Care Plan. However, if you wish not to receive CPR, this happens, your healthcare providers you may get a doctor to sign a Do Not Resuscitate will work with the Healthcare Agent order or a MOST form. EMS personnel will follow named in your Healthcare Power of these orders. Attorney, or a surrogate medical decision maker (see the definitions section), to Can a doctor override my Advance Care Plan? determine the best treatment that is consistent with your previously expressed Q Your physician is ethically obligated to follow your wishes. This is why it is important to wishes as set forth in your Advance Care Planning TALK with your doctors and the people documents; however, if he or she disagrees with closest to you about your values and A your wishes, a physician can transfer care to your wishes. This will relieve people who another physician as long as continuity of medical care about you of some of the stress they care is assured. will experience if you become very ill and unable to communicate. Will my desire not to receive CPR Whom should I choose as Q be honored? Q my Healthcare Agent? You may reflect on your Advance Care Planning This is an important choice since he or documents that you do not wish to have A she will have the authority to direct your Cardiopulmonary Resuscitation (CPR), but that wish healthcare if you become too sick or A must be made into a medical order by a physician. injured to make an informed decision. If you are at risk for cardiac or respiratory arrest, You should TALK to the person you wish your physician should TALK with you about the risks to be your Healthcare Agent to explain and benefits of CPR so that you may agree on what your intentions, discuss their to do if this happens. You and your Healthcare understanding of your wishes, and Agent should ask about this if it is not brought up by confirm their willingness to act on your your doctor. If you wish to have a Do Not behalf. Choose someone who Resuscitate order outside of a hospital, you will need understands your values and choices, and a Portable Do Not Resuscitate order. who is willing to honor them. What kinds of medical care are included Q in my Advance Care Planning How can I be sure that my wishes will documents? Q be followed? You may direct both general healthcare A choices, and end-of-life care choices. General Your Healthcare Agent or surrogate healthcare may include such care as dialysis, A medical decision maker is required by law chemotherapy, blood transfusions, to follow your stated wishes. If your cardiopulmonary resuscitation (CPR), or any wishes are not clear, that person must other treatment that you do or do not want if you use his/her knowledge of your wishes and are unable to speak for yourself. Your end-of- values to make the decisions that you life instructions may include the above as well would have made for yourself. as life prolonging measures such as mechanical ventilation, artificial nutrition, and artificial hydration or withholding or withdrawing 8 treatment. Does my Advance Care Plan allow me to Will my Advance Care Plan be followed donate my body to medical science or Q in states other than North Carolina? Q donate my organs after my death? Most states have laws allowing individuals to make decisions regarding their A Yes. There are several things you should do to healthcare agents and medical make this an easier process: treatments. However, these laws may be A different than North Carolina's laws. If • TALK to your Healthcare Agent about your you move to another state, you should wishes. Your Healthcare Agent is obligated determine if your North Carolina form is by law to follow your wishes about these valid in that state. gifts. • TALK with your family so that they Can I change my mind about my understand your intentions. Advance Care Plan? Q Communicate your wish to be an organ • donor on your Advance Care Plan, on your Yes. You can change all or any portion driver’s license, or on the internet at of, or revoke your Advance Care Planning A www.donatelifenc.org documents at any time. Here’s how: • Change any portion that you desire on If you wish to leave your body to medical the document, initial the change and • science, you will need to make have two witnesses sign along with a arrangements through one of North notary (following the same rules Carolina's Medical Schools or research regarding witnesses outlined on page programs. 5). Make sure these changes can be easily read. OR Revoke the entire document with a What should I do when I have completed my • signed, dated written statement. OR Advance Care Plan? Write “Revoked” across the Q • document and sign and date where Make copies and give them to your doctors and you have written “Revoked.” * OR your Healthcare Agent(s), and keep the original Tear up or destroy the old Advance A for your own files. You have two options to • Care Planning document(s) and all register your Advance Care Plan: copies; - The North Carolina Advance Health Care Directive Registry for a fee at Then: www.secretary.state.nc.us/ahcdr/ - Create a new Advance Care Plan - The US Living Will Registry, which is free of in writing and be sure it is signed, charge through Sentara. More information dated and witnessed. Old versions about the US Living Will Registry is provided should be destroyed. with the Sentara Advance Care Plan form and at www.sentara.com. - Tell your physician that you have changed your Advance Care Plan. NOTE: Any time you create a new Advance Care Plan, please send a new copy and a new * We strongly recommend as the best option to write "Revoked" and Registration Agreement to whichever Registry sign/date directly under. This validates your intent should copies you choose to utilize. later surface. If you need assistance with updating or revoking your Advance Care Plan, contact Sentara Albemarle Medical Center (252) 384-4125 or the Sentara Center for Healthcare Ethics at (757) 252-9550 or 9 1-800-Sentara (736-8272) MY ADVANCE CARE PLANNING GUIDE If you have any questions about your Advance Care Plan, or if you wish to set an appointment with one of our Certified Advance Care Planning Facilitators, please contact: Sentara Center for Healthcare Ethics [email protected] Call (757) 252-9550 or 1-800-Sentara (736-8272) Additional copies of this booklet may be downloaded on your computer by visiting: www.sentara.com This booklet is not intended as legal advice and you may wish to speak with an attorney before signing your Advance Care Plan.