Answers to Common Questions About Medical Care Decisions
Following is a list of our patients' most frequently asked questions.
An advance directive (AD) is a legal document about your medical wishes that is used when you cannot speak for yourself. An AD is created today for use by others at a later date. The two main types of AD are a Health Care Power of Attorney (HCPOA) and a Living Will. North Carolina has a separate AD used for mental health treatment. In South Carolina and Virginia, there is not a specific form for mental health treatment. Those wishes may be included in a HCPOA.
Having an AD is the best way to ensure that your values and preferences are known and honored by those who are important to you and by your healthcare providers. An AD gives peace of mind to those you care about by letting them know what you would have wanted if you were able to speak for yourself. When you give them this gift, you can spare them from having to guess or second-guess the decisions they may be asked to make for you.
A HCPOA is a legal document used to name a person - called your "healthcare agent" - to make medical decisions for you if you lose the ability to make those decisions for yourself.
A living will is a legal document that describes the life-prolonging treatments you would like to receive - or not receive - in the event that you have a serious condition from which you cannot recover or will not regain consciousness.
This is a North Carolina-specific legal document that allows you to limit the types of treatments you would receive for a mental health condition. It does not allow you the right to refuse an involuntary commitment if you are mentally ill and dangerous to yourself or others. In states that do not have an "Advance Instruction for Mental Health Treatment," mental health wishes may be included in a HCPOA.
You may complete either one or both. The HCPOA is powerful because it gives your decision-making authority to another person. In general, an HCPOA is a more useful document because it allows your healthcare agent to "step into your shoes" and make any decision - including end of life decisions - that you could not make for yourself. However, it is not enough to simply name someone to make decisions for you. The real value of an HCPOA stems from the conversations that you have with your healthcare agent. By sharing your goals and preferences, you give your healthcare agent the information needed to make decisions that you would have made yourself Then they know exactly what you want as opposed to guessing or making decisions based on what your agent believes is best for you. The Living Will is valuable because it informs others that you had considered your values and preferences regarding life-prolonging treatments in advance. Because the circumstances in which a living will comes into play are limited, it is wise to also name a healthcare agent and share your end-of-life preferences with that individual.
A healthcare champion is someone who can speak up for you and support you. When you take the extra step of completing the legal document to make your healthcare champion your healthcare agent, you make it easier for that person to support you. A healthcare agent will not be challenged when seeking access to important medical records, selecting medical providers, obtaining billing information, or signing papers in treatment settings outside the hospital. When your loved ones are clear about who you chose to make your medical decisions, they can focus on other ways to support you and your agent.
The best way to ensure that your wishes are honored is to name a healthcare agent and create a legal document. Many patients, however, will not take the steps to create a legal document. We believe that it is important to know the name of the individual that our patients choose as their "healthcare champion." To the extent that we are legally able to do so, we will honor our patient's wishes in naming a "healthcare champion." If the "healthcare champion" is not also named as legal healthcare agent, however, he or she might not be able to make decisions for you at other healthcare facilities.
It is important that you discuss your values and preferences with the person you plan to appoint as your healthcare agent to find out if they feel capable of honoring your choices. In the living will, you will have the ability to allow your healthcare agent to override your wishes or to follow your wishes stated in the living will.
No. Your healthcare agent makes medical decisions for you and may be asked to evaluate treatment options based on cost to you. Your healthcare agent is not financially responsible for your care unless the person is otherwise legally responsible for your living expenses (for example, your husband, wife or guardian).
No. It is not necessary to consult with a lawyer. We have made it easy for you to find and complete the AD forms on your own or we can arrange for you to speak with an Advance Care Planner by calling toll-free 1-844-677-5134 or requesting an appointment by email at firstname.lastname@example.org. If you already have an attorney for general estate planning, you may want to ask for advice about completing the forms. You also may ask your attorney to keep a copy of your AD on file with your other estate documents.
It depends on where you live. North Carolina law requires that an AD be notarized. Virginia law does not. In South Carolina, a living will must be notarized, but it is optional to have a HCPOA notarized. This means that a HCPOA is valid in South Carolina either with or without notarization.
Novant Health offers free guidance and assistance for notary services. If you choose to have your documents notarized outside of Novant Health, you may have to pay for notary services.
We offer free notary services when we assist you with your advance care planning. You may call toll-free 1-844-677-5134 or email us at email@example.com and we will assist you with getting your document notarized. If you print and complete your documents at home, remember not to sign them until you are with the notary and witnesses. When you come to get your documents signed and notarized, you will need to bring a valid ID with you (either current driver's license or passport).
Now! Since we can never predict when we might have an accident or serious illness, we recommend that every adult over 18 consider appointing a healthcare agent. At any age, it is important to share with others your values and preferences for medical treatments that would serve only to prolong your life.
In a place where it can be easily retrieved and used when needed! If you make a HCPOA, be sure to give a copy to your healthcare agent. You will also want to make enough copies so you can give one to your healthcare providers and other people who are important in your life. It is helpful to keep a list of who has your documents in case you change your mind at a later date. Unlike some legal documents, an AD does not have to be filed with a court clerk.
Here are the ways that you can do this:
MyChart - if you have a MyChart account, you may upload your advance directive directly into MyChart. Simply scan all of the pages for your advance directive into a single document and upload it to your chart.
Appointment with your healthcare provider - You may take a copy of your advance directive to your next appointment and ask your provider to place it in your medical record.
You may change your mind at any time as long as you have the capacity to make decisions. All you have to do is tell someone about your new wishes or create a new HCPOA document. It is wise to destroy prior copies of your HCPOA.
We understand that it may be difficult to choose one person to be your healthcare agent, particularly if you are trying to choose between your adult children. All of the official state forms provide space for you to name one main agent and a second person to serve as an alternate if the first person is unable or unwilling to make medical decisions for you. Although it is best to name one person, you may share your wishes that this individual collaborates with others to make decisions for you. A danger of naming more than one person is that the individuals may disagree about your care. If you feel strongly that you want to name more than one person, you will need to seek an attorney for help in creating a customized AD. If you choose to do so, we strongly recommend that you also include directions on how to resolve disagreements between your healthcare agents.
It is not uncommon for people to change their minds about care at end-of-life as their health condition changes. You may change your mind at any time by making new choices - verbally or in writing. To avoid confusion about what you want, it is wise to destroy prior copies of your living will.
No. However, we recommend that you discuss your values and preferences with your doctor and other healthcare providers. As mentioned earlier, you should give all of your providers a copy of your AD.
No. Federal law requires us to ask whether you have an AD each time you are admitted to the hospital. This ensures that we are aware of your preferences; however, there is no requirement for you to have an AD as a condition of treatment. It's your choice.
State law tells us who will decide for you if you don't make a choice. If you don't have a healthcare agent or a legally appointed guardian with the authority to make your healthcare decisions, we will turn to the following people, in this order:
North Carolina If you do not have a healthcare agent or guardian and you are not able to make your medical decisions, then these are the people - in the order listed - who have the legal right to make decisions for you:
Your husband or wife (even if you are legally separated); or
A majority of your reasonably available parents and children who are at least 18 years old; or
A majority of your reasonably available brothers and sisters who are at least 18 years old; or
An individual who has an established relationship with you, is willing to act on your behalf and can reliably convey your wishes.
If none of those persons is reasonably available, then your doctor may provide treatment without your consent as long as another doctor agrees that you need the treatment.
South Carolina If you do not have a healthcare agent or guardian and you are not able to make your own medical decisions, then these are the people - in the order listed - who have the legal right to make decisions for you:
Your husband or wife (unless you are formally separated); or
Your parent or adult child; or
Any of your adult brothers, sisters, grandparents or grandchildren; or
Any other relative by blood or marriage who is reasonably believed to have a close personal relationship with you.
Any of the individuals listed above will not have priority over others if your healthcare provider had actual knowledge that you did not want that person involved in decisions concerning your care.
Virginia If you do not have a healthcare agent or guardian and you are not able to make your own medical decisions, then these are the people - in the order listed - who have the legal right to make decisions for you:
Your husband or wife (but not if a divorce action has been filed); or
Your adult child; or
Your parent; or
Your adult brother or sister; or
Any other relative in descending order of blood relationship; or
Any adult who: a) is not a director, employee or adult of the healthcare family where you are being treated; b) has exhibited special care and concern for you; and c) is familiar with your religious beliefs, basic values and preferences previously expressed by you. *This person cannot give consent to withhold or withdraw a life-prolonging procedure and two physicians must decide whether an adult meets these criteria.
Sometimes a husband or wife is the very best person to know your values and preferences and sometimes it can be very hard for that person to honor your wishes instead of their own. Here's a list of characteristics to look for in a medical champion. There are many other ways for your husband or wife to support you besides being your medical decision maker.
Doctors will tell you about your medical condition, the different treatment options that are available, and what may happen with each type of treatment. They give you guidance but the decision to have a treatment, refuse a treatment or stop a treatment is yours.
Most states will honor an advance directive from another state. If you spend a lot of time out of state, you may wish to make an AD using the special forms of the state you are visiting.
No. You do not need to register your AD but may do so if you choose. There is a national registry called US Registry. Some, but not all, states also have advance directive registries. For more information on how to register your AD, you may visit the following websites: