By Annette Dunlap
Most of us worry about
being a burden to our loved ones when
we go to the hospital. We want to ease
their anxiety and assure them that we will
be all right.
One way to offer additional assurance is
to file advance medical directives before
we need special treatment or a surgical
Advance directives are valuable tools
that protect our right to make medical
choices that affect our lives. These documents
also reduce the stress on family
members, because we have expressed
our own wishes regarding our
medical treatment, and they may
help prevent potential legal complications.
State law governs the validity
of advance directives. In North
Carolina, there are several
that address health
and medical decisions:
medical directives, do
not resuscitate orders,
Health Care Power of
Attorney, a power of attorney
that gives another person access
to your medical information under
the HIPAA laws, and Declaration
of a Desire for a Natural Death or “Living Will.”
In many cases, a physician must determine whether
or not a patient’s condition is determined to be terminal
and incurable or if the patient is in a persistent
vegetative state before the provisions of the directives
can be activated.
“Each of these documents requires thought and
consideration,” says Victoria P. Brenner, a local estate planning
attorney who encourages people to consider
drawing up advance directives as part of overall estate
Medical directives outline the steps that a person
wishes to have taken should he or she ever become
incapacitated and if physicians do not expect the individual
to recover. They are the individual’s directions
regarding specific treatments.
Information covered in a medical directive outlines
the treatment a person does and does not want, such
as certain forms of pain relief, dialysis, feeding tubes,
respirators or cardiopulmonary resuscitation (CPR.)
“The ‘do not resuscitate’ (DNR) order is a special
order that can only be written and placed on
the patient’s medical record by a physician,” says
Chuck Moak, a patient services representative with
FirstHealth Moore Regional Hospital.
A DNR order states that CPR will not be used on
a patient when his or her heart or breathing stops.
According to Moak, patients who have completed the
advance directive package often think they can just
tell medical personnel that they do not want to be
resuscitated. But that’s not sufficient. A DNR must
be written by a physician, who will typically issue the
order when he or she has determined that a patient is
in a terminal, incurable or persistent vegetative state.
The physician does so with the patient’s knowledge
or with the knowledge of the patient’s health care
power of attorney.
Moak encourages patients who do not want to be
resuscitated to discuss their wishes with their physician.
And a note: DNR orders often do not apply
Health care power of attorney
“The Health Care Power of Attorney appoints
someone to make health and medical decisions for
you if you become incapacitated or incompetent,”
Its provisions are enacted when certain medical
conditions prevent an individual from expressing his
or her own wishes. The physician must state, in writing,
that the patient can no longer understand sufficiently,
or does not have the mental capacity to make
decisions regarding his or her health care.
Irreversible brain damage, a permanent coma or a
terminal illness that may lead to a loss of consciousness
are some of the conditions under which a Health
Care Power of Attorney would be used.
HIPAA power of attorney
Under current federal law (part of the Health
Insurance Portability and Accountability Act or
HIPAA), medical information is confidential between
the patient and the health care provider. However,
individuals who feel that it is a good idea to allow
another person access to their medical records can
grant a power of attorney to a person of their choice.
For more information on HIPAA and what it
means to you as a consumer of health care, please see
the related story Your right to privacy.
In North Carolina, the formal term for a “living
will” is “Declaration of a Desire for a Natural Death.”
This document allows individuals to state their wishes
regarding the use of extraordinary measures, artificial
nutrition and/or hydration to keep them alive.
Before a “living will” can be executed, a physician
has to determine that the individual in
question is terminal or in a persistent vegetative
state. Typically, this means that the person has
lost the ability to think or reason and will die if
the artificial means of keeping him or her alive is
Individuals must be mentally competent when
they draw up a living will, and the document
must be signed and dated in front of two witnesses
and a notary.
“The law is very specific about who is eligible to
witness the signing of a living will,” says Moak. “In
general, none of the witnesses can be in a position to
benefit from the person’s death, so a person’s family
members, physician or health care provider or beneficiaries
named in other wills—anyone with a vested
interest—cannot serve as witnesses.”
Put documents in place
Once you have completed your advance directives,
put them in place so that they will be accessible when
needed. Also place a copy of your directives with your
medical record at your hospital.
FirstHealth offers a kit that explains advance directives
and provides forms for you to document your
wishes regarding your care.
Family members should be able to locate copies
of the document, and the individual (or individuals)
granted health care power of attorney and power of
attorney should also have copies.
If you use an attorney to draw up your documents,
keep a copy on file with that office, too.
Finally, be aware that these documents are not
reciprocal from state to state. That means that a
document prepared in one state may not meet the
requirements of another and vice versa.