Advance Directives - Put it in Writing

Through a law known as the Patient Self Determination Act, all hospitals and other healthcare institutions must inform patients of their rights to agree to or refuse medical treatment and to make advance directives. An advance directive allows you to state your wishes, or name someone who will state your wishes for you, to receive or refuse medical treatment if you are unable to make decisions for yourself.

In most cases, you can discuss your course of medical treatment with your physician and family. Only when you are unable to speak for yourself is your advance directive activated. You do not have to make a decision about your health care now, but discussing your wishes with family members in advance can make dealing with a healthcare emergency a bit easier.

Frequently Asked Questions

What is an Advance Directive?

An advance directive is a legal document that outlines your specific wishes regarding health care in the event you lose the ability to make decisions for yourself. In West Virginia, a living will and a medical power of attorney are advance directives.

What are my rights?

Under the Patient Self-Determination Act, every patient, at least 18 years old and mentally competent, has the right to accept or refuse medical treatment. If you want to control decisions about your health care, even if you become unable to make or to express them yourself, you will need an advance directive. Any time you are admitted to the care of a hospital, skilled nursing facility, home health care agency or hospice, you will be asked about advance directives.

What if I don't have an Advance Directive?

You are not required to have a living will or a medical power of attorney. If you do not have an advance directive and become unable to make decisions for yourself, your physician or health care provider will consult with someone close to you about your care.

What is Cabell Huntington Hospital's policy on advance directives?

Cabell Huntington Hospital recognizes and respects the rights of its patients to agree to or refuse medical treatments and will comply with its patients' advance directives as long as the wishes can be understood and can be carried out according to the law. If the patient's wishes cannot be understood or if questions arise about the use of advance directives, a consultation with the Ethics Committee can be requested by the patient, the patient's family or the caregiver.

It is Cabell Huntington Hospital's responsibility to:

• Ask patients if they have an advance directive
• Provide patients with written information regarding advance directives
• Document in the patient's medical record if an advance directive has been given

Also, a living will or medical power of attorney is not required in order to receive medical treatment at Cabell Huntington Hospital.

What is a Living Will?

A living will is a legal document that tells others that you want to die naturally, should you become terminally ill or in a persistent vegetative state from which you will not recover. You can tell your physician whether or not to use treatments that would delay your dying, such as using a breathing machine (respirator) or giving you food and water through a tube (artificial nutrition or hydration).

What is a Medical Power of Attorney?

When you complete a medical power of attorney, you designate a person to make medical care decisions on your behalf only when you cannot make those decisions for yourself. In this document, you name your representative and what medical treatments you would or would not want.

How do I choose a representative?

You should select someone you are close to and can trust to carry out your wishes. You must put the names of your first and second choices of representatives in writing and share a copy of the medical power of attorney with each representative.

How do I make an advance directive?

Because a living will and medical power of attorney are legal documents, there are a few rules you must follow to ensure your wishes are clear and will be carried out. Both a living will and medical power of attorney must be written out and signed by you while you are still able to understand your medical condition and treatment choices. Both types of advance directives must be witnessed by two qualified people, and each document must be notarized.

Are there forms I can use to make an advance directive?

Yes, there are forms for both the living will and medical power of attorney. These forms meet all of the rules for a formal advance directive in West Virginia. Click on the specific link below for forms and instructions:

Medical Power of Attorney or Living Will to review and/or print them. You may also download instructions on how to complete the forms.

When is an advance directive used?

A living will goes into effect when it is determined you are going to die and cannot be cured, or when you are in a persistent vegetative state. Your medical power of attorney goes into effect when your doctor states in writing that you are not able to make known your health care choices. When you make a medical power of attorney, you can name the doctor you want to determine whether you are able to make health care choices.

What happens if I change my mind?

You can cancel or change your living will or medical power of attorney by (1) destroying all copies of it; (2) making a new living will or medical power of attorney; or (3) by telling your physician and, in the case of a medical power of attorney, each of your representatives of your desire to cancel or change it. If you have more than one living will or medical power of attorney, the one that was most recently created will be honored.

Whom should I talk to about my advance directives?

You should discuss your advance directives with your family and your physician. Your physician can answer any medical questions you may have. If you have any questions about the law, talk with your lawyer. Some people also discuss their decisions with clergy or other trusted advisors.

Where should I keep my advance directives?

Keep a copy in a safe place where your family members can get to it. Give copies to your family, your doctor or other health care provider, your representative(s) and any close friends who might be asked about your care.

Do I have to complete my advance directives before I am hospitalized?

No. You can obtain a copy of the advance directive forms from the nursing staff or the Social Work department at Cabell Huntington Hospital, or simply print the forms for Living Will, Medical Power of Attorney, or Medical Power of Attorney and Living Will combined which are available under the question “Are there forms I can use to make an advance directive?” above.  A nurse or a member of Social Work can assist you with the forms and help get them notarized. Bring copies of your advance directive with you when you come to the Hospital for treatment or to be admitted.

A nurse or a member of Pastoral Care or Social Work can assist you with the forms and help get them notarized. Bring copies of your advance directive with you when you are admitted to the hospital.

What if I have an advance directive from another state?

Cabell Huntington Hospital will honor an advance directive that has been signed, notarized and completed in accordance with that state's laws.

Do I have to pay to complete my advance directive at Cabell Huntington Hospital?

There is no charge for completing and notarizing advance directives at Cabell Huntington Hospital. A few things to consider when completing your advance directives:

• Being totally dependent on the care of others
• The conditions that would make life intolerable to you
• Artificial life-support
• The financial aspects of prolonging life
• Death
• Autopsy
• Organ donation

If your condition were one of the following, what medical treatment would you want or not want?

• Severe brain damage
• Chronic pain
• Permanent coma
• Incurable cancer
• Advanced Alzheimer's Disease
• Severe disability

If necessary to prolong your life, would you want:

• Cardiopulmonary Resuscitation (CPR)
• Mechanical ventilation (machines that breathe for you)
• Chemotherapy and/or radiation therapy
• Kidney dialysis
• Blood transfusions
• Antibiotic therapy
• Artificial feeding (tube feeding)
• Artificial hydration (fluid through intravenous lines)

Will the care I receive change if I make an advance directive?

Remember, if you have an advance directive you will receive the same quality of care all of our patients receive. Cabell Huntington Hospital will make every patient as comfortable as possible.

Where can I get more information?

You may learn more about advance directives by calling Clinical Resource Management at 304.526.2090.

Any questions or concerns regarding the advance directives requirements may also be directed to the Office of Health Facility Licensure and Certification of the West Virginia Department of Health and Human Resources in Charleston, WV.