Advance Directives

What are "Advance Directives"?
Advance directives are documents that state your choices about medical treatment or name someone to make decisions about your medical treatment, if you are unable to make these decisions or choices yourself. They are called "advance" directives because they are signed in advance to let your doctor and other healthcare providers know your wishes concerning medical treatment. Through advance directives, you can make legally valid decisions about your future medical care.

North Carolina law recognizes 3 types of advance directives:

• A Declaration (Living Will)
• Health Care Power of Attorney
• An Advance Instruction for Mental Health Treatment

Do I need an Advance Directive?
No, it is entirely up to you whether you want to prepare any documents. But if questions arise about the kind of medical treatment that you want or do not want, advance directives may help to solve these important issues. Your doctor or any healthcare provider cannot require you to have an advance directive in order to receive care; nor can they prohibit you from having an advance directive. Moreover, under North Carolina law, no healthcare provider or insurer can charge a different fee or rate depending on whether or not you have executed an advance directive.

What will happen if I do not make an Advance Directive?
If you cannot speak for yourself and have not made an advance directive, your doctor or other healthcare providers will generally look to your family or friends for decisions about your care. But if your doctor or your healthcare facility is unsure, or if your family members cannot agree, they may have to ask the court to appoint a person (called a guardian) to make those decisions for you.

How do I know what treatment I want?
Your doctor must inform you about your medical condition and what different treatments can do for you. Many treatments have serious side effects. Your doctor must give you information, in language that you can understand, about serious problems that medical treatment is likely to cause. Often, more than one treatment might help you, and different people might have different ideas on which is best. Your doctor can tell you the treatments that are available to you, but he cannot choose for you. That choice depends on what is important to you.

Whom should I talk to about Advance Directives?
Before writing down your instructions, you should talk to those people closest to you and who are concerned about your care and feelings. Discuss them with your family, your doctor, friends and other appropriate people, such as a member of your clergy or your lawyer. These people who will be involved with your healthcare if you are unable to make your own decisions.

When do Advance Directives go into effect?
It is important to remember that these directives only take effect when you can longer make your own healthcare decisions. As long as you are able to give "informed consent", your healthcare providers will rely on you and not on your advance directives.

What is "Informed Consent"?
Informed consent means that you are able to understand the nature, extent and probable consequences of proposed medical treatments, you are able to make rational evaluations of the risks and benefits of those treatments as compared with the risks and benefits of alternate procedures, and you are able to communicate that understanding in any way.

How will healthcare providers know if I have any Advance Directives?
All hospitals, nursing homes, home health agencies, HMOs and all other healthcare facilities that accept federal funds must ask if you have an advance directive, and if so, they must see that it is made part of your medical records.

Will my Advance Directives be followed?
Generally yes, if they comply with North Carolina law. Federal law requires your healthcare providers to give you their written policies concerning advance directives. It may happen that your doctor or other healthcare provider cannot or will not follow your advance directives for moral, religious or professional reasons, even though they comply with North Carolina law. If this happens, they must immediately tell you. Then they must also help you transfer to another doctor or facility that will do what you want.

Can I change my mind after I write an Advance Directive?
Yes, at any time, you can cancel or change any advance directive that you have written. To cancel your directive, simply destroy the original document and tell your family, friends, doctor and anyone else who has copies that you have cancelled them. To change your advance directives, simply write and date a new one. Again, give copies of your revised documents to all the appropriate parties, including your doctor.

Do I need a lawyer to help me make an Advance Directive?
A lawyer may be helpful and you might choose to discuss these matters with him, but there is no legal requirement in North Carolina to do so.

Will my North Carolina Advance Directive be honored in another state?
The laws on advance directives differ from state to state, so it is unclear whether a North Carolina advance directive will be valid in another state. Because an advance directive is a clear expression of your wishes about medical care, it will influence that care no matter where you are admitted. However, if you plan to spend a great deal of time in another state, you might want to consider signing an advance directive that meets all the legal requirements of that state.

Will Advance Directives from other states be valid in North Carolina?
An advance directive executed in another state may not meet all the requirements of North Carolina law. To make sure you have a legal advance directive, you should execute North Carolina forms or have your attorney review the advance directive from the other state.

What should I do with my Advance Directives?
You should keep them in a safe place where your family members can get to them. Do not keep the original copies in your safe deposit box. Give copies of these documents to as many of the following people as you are comfortable with: your spouse and other family members; your doctor; your lawyer; your clergyperson; and any local hospital or nursing home where you may be residing. Another idea is to keep a small wallet card in your purse or wallet that states that you have an advance directive and who should be contacted.