Advance Care Planning

Have you thought about the type of care and medical treatment you may want should you ever become unable to make decisions or speak for yourself?

It’s hard for most of us to imagine this scenario, especially when we are young and healthy. However, you never know when you may experience a medical emergency. A car accident or sudden illness can leave you incapacitated and in need of serious medical care.

Advance care planning is making decisions about the healthcare you would want to receive if you’re facing a medical crisis. These are your decisions to make based on your personal values, preferences, and discussions with your loved ones. Advance care planning helps you prepare for the unexpected while you are well and able to make difficult decisions for yourself.

Questions? Please call Mary Washington Healthcare Patient Relations Department 540.741.3955.

Being Prepared in the Time of COVID-19: The Conversation Project

Advance care planning includes:

• Getting information on the types of life-sustaining treatments that are available.
• Deciding what types of treatment you would or would not want should you be diagnosed with a life-limiting illness.
• Sharing your personal values with your loved ones.
• Documenting in writing what types of treatment you would or would not want – and who you chose to speak for you, should you be unable to speak for yourself.

82% of people say it’s important to put their wishes in writing, but only 23% have done it.

The Virginia Health Care Decisions Act allows you to make two types of decisions about your end-of life healthcare in an Advance Directive.

• First Type of Decision: If you are ever diagnosed with a terminal condition and are incapable of making your own decisions, you have the right to create a living will in advance. This is essentially a document that communicates whether or not you want life-prolonging procedures.
• Second Type of Decision: If you can’t make treatment decisions due to a medical condition, you can name someone in advance to make those decisions for you. This is often referred to as a health care proxy, a medical power of attorney, or a durable power of attorney. Whoever is named in this second type of decision is given power to make decisions you would have made in the same situation if you were able. In some cases, you can put parameters around the decisions that the person named is allowed to make. The law prohibits the person you choose from making decisions that would contradict your religious convictions, basic values, and spoken preferences. You may also choose a person to ensure that your organs or body are donated after your death.

Please remember to bring your or your loved one’s Advance Directive to the hospital.

The Patient Self-Determination Act was passed by Congress in 1990. Under this act, healthcare institutions are required to inform their patients and their communities about their rights to make decisions concerning their medical care. Accepting care, refusing care, and making advance directives about their care are included under these rights.

Ask the Experts: Advance Care Planning

Advance Directives

An Advance Directive consists of legal documents that put your medical wishes in writing and allows you to choose someone you trust to make healthcare decisions for you. These documents offer peace of mind that, should the unthinkable happen, you’ve made your wishes known.

Preparing an Advance Directive is also an important gift to your loved ones. They will rest easier knowing they are making medical decisions based on what you do or do not want.

Advance Directive Links for Virginia Residents

Virginia Advance Directive Short Form

Virginia Advance Directive Form for Healthcare with Sections for Medical, Mental, and End-of-Life Care - short (pdf)

Virginia Advance Directive Form for Healthcare with Sections for Medical, Mental, and End-of-Life Care - full (pdf)

Virginia Advance Directive Form for Healthcare with Sections for Medical and End-of-Life Care (pdf)

Virginia Advance Directive Form for Mental Health Care (pdf)

Living Will

A Living Will documents your wishes for medical care should you ever be unable to speak for yourself due to a serious illness or accident.

Examples of medical treatments addressed in a Living Will:

• CPR (restarts heart if it stops)
• Breathing tube (mechanical ventilation)
• Kidney dialysis (if kidneys fail)
• Artificial hydration or nutrition

A Living Will is different from a Last Will & Testament, which directs how you wish to distribute your assets and property upon your death.

Medical Power of Attorney / Healthcare Agent

A Medical Power of Attorney gives a trusted person the legal power to make decisions on your behalf if you cannot.

Depending on where you live, the person you choose to make decisions on your behalf may be called one of the following:

• Healthcare agent
• Healthcare proxy
• Healthcare surrogate
• Healthcare representative
• Healthcare attorney-in-fact
• Patient advocate

Choosing a person to act as your healthcare agent is important. Even if you have other legal documents regarding your care, not all situations can be anticipated and some situations will require someone to make a judgment about your likely care wishes. You should choose a person who meets the following criteria:

• Meets your state's requirements for a healthcare agent
• Is not your doctor or a part of your medical care team
• Is willing and able to discuss medical care and end-of-life issues with you
• Can be trusted to make decisions that adhere to your wishes and values
• Can be trusted to be your advocate if there are disagreements about your care

The person you name may be a spouse, other family member, friend or member of a faith community. You may also choose one or more alternates in case the person you chose is unable to fulfill the role.

Virginia Advance Directive Form to Appoint a Healthcare Agent (pdf)

Optional Documents (including DNRs)

You don't need to have an advance directive or living will to have do not resuscitate (DNR) and do not intubate (DNI) orders. To establish DNR or DNI orders, tell your doctor about your preferences. He or she will write the orders and put them in your medical record.

Even if you already have a living will that includes your preferences regarding resuscitation and intubation, it is still a good idea to establish DNR or DNI orders each time you are admitted to a new hospital or health care facility.

• Do Not Resuscitate (DNR): Don’t restore heart if it stops or beats unevenly while you are in the hospital.
• Do Not Intubate (DNI): No breathing machine if you cannot breathe on your own.
• Durable Do Not Resuscitate (DDNR): A special DNR order that your doctor can provide you so that EMS, fire, and rescue and any health care provider will know your wishes about resuscitation. Note: copies of DDNR forms are now valid in Virginia, and DDNR forms may be downloaded (to bring to your physician) at the Office of Emergency Medical Services website.
• Physician Order or Medical Order for Life-Sustaining Treatments (POLST or MOLST): These physician orders are for people who have already been diagnosed with a serious illness. This form does not replace your other directives. Instead, it serves as doctor-ordered instructions - not unlike a prescription - to ensure that, in case of an emergency, you receive the treatment you prefer. Your doctor will fill out the form based on the contents of your advance directives, the discussions you have with your doctor about the likely course of your illness and your treatment preferences.
• A POLST / MOLST stays with you. If you are in a hospital or nursing home, the document is posted near your bed. If you are living at home or in a hospice care facility, the document is prominently displayed where emergency personnel or other medical team members can easily find it.
• Organ and Tissue Donation: Permission to donate organs if you die.

Action Steps

• Create a Living Will and Medical Power of Attorney (MPOA)
• Store documents in a safe but accessible place
• Discuss your wishes with your doctor
• Give a copy of your Advance Directive to your doctor
• Carry an Advance Directives wallet card (see Items to Print)
• Review documents periodically in case your wishes change
• Questions? Please call Mary Washington Healthcare Patient Relations Department 540.741.3955..

Frequently Asked Questions (FAQs)

Frequently Asked Questions provided by the Virginia Bar Association:

Why Create an Advance Directive?

An Advance Directive allows you to state your choices for healthcare or to name someone to make those choices for you, if you become unable to make decisions about your medical treatment. It enables you to say "yes" to treatment you want, or "no" to treatment you do not want.

What Kind of Advance Directive Do I Need?

You may execute a power of attorney for healthcare, a written healthcare directive, or both. Of the two kinds of Advance Directives, a power of attorney for healthcare is broader. A written healthcare directive is helpful in stating your wishes, but it may not be possible to anticipate all possible medical situations for which your written healthcare directive might apply. The best way to protect your interests, however, is to execute both.

Are Advanced Directives Only for End-Of-Life Issues?

No. Advance directives may address any type of care in situations in which you cannot make decisions for yourself. For example, an advance directive may address psychiatric (mental health) issues, chronic disease issues, and wishes about admissions to certain types of healthcare facilities.

Can I Just Say My Wishes Orally?

You should always share your healthcare wishes with your loved ones and your doctors. However, you may only create an Oral Advance Directive if you have a terminal condition and tell your wishes directly to your doctor. Also, putting your wishes in writing reduces confusion about your wishes since people often forget or misunderstand what was said orally.

What if I’m Unsure of What Healthcare I May Want?

You should still execute an Advance Directive to describe the important values and beliefs you have. You can also indicate your religious beliefs. Often, these types of statements will help others make appropriate healthcare choices for you when you cannot make them yourself.

I Don’t Know Medical Terms. What Do I Need to Say?

You can, and should, put your wishes in your own words. Just describe as best you can what medical care you do and do not want.

I’m Young And/or in Good Health. Do I Need an Advance Directive?

Yes. No one knows what the future might bring. For example, you might need someone to make medical decisions for you in the event that you suffer a sudden injury or illness (such as a car accident). It is better to choose this person in advance and tell him or her about your healthcare wishes. If you do not choose someone in advance, the law will assign a decision maker who must guess about your wishes.

Who Should I Pick as My Healthcare Power of Attorney?

You may appoint any adult (18 years or older). This person needs to be accessible, but he/she does not need to live in Virginia. When you choose your agent, make sure that you have chosen someone who will be able to make potentially difficult decisions about your care, is willing to serve as your agent, and is aware of your wishes. You should also choose an alternate in case your first choice is unavailable (for example, your first choice may not be found or may not be willing to be your agent).

I Have Several Children. Can I Appoint All of Them?

You really should pick just one person as your agent. Picking more than one person can result in a conflict, delay decision-making, or result in an inability to make any decision at all. You can include your other children by letting them know your choices. You may also require your one agent to talk with your other children prior to making any decisions.

If I Appoint an Agent Will I Lose My Ability to Make My Own Decisions?

No. Your agent only gets to make healthcare decisions for you if your doctor and another doctor or licensed clinical psychologist examine you and determine you cannot make decisions for yourself. Furthermore, as soon as you can speak for yourself again, decision-making authority returns to you.

What if I Change My Mind?

You may cancel or modify your Advance Directive at any time, but it is important that you tell others that you have canceled or changed your Advance Directive.

What Does It Mean to Have a Terminal Condition?

It means that your doctor has determined that you are likely to die soon or that you are in a persistent vegetative state, which is when you have no awareness of your surroundings and your doctors have determined you will not recover.

What Does Life-Prolonging Treatment Mean?

It means using machines, medicines, and other artificial means to help you breathe, eat, get fluids in your body, have a heartbeat, and otherwise stay alive when your body cannot do these things on its own. Life-prolonging treatment will not help you recover. It does not include drugs to keep you comfortable.

I Do Not Want to Limit My Care if I Have a Terminal Condition. Will an Advance Directive Help Me?

Yes. Your Advance Directive will enable your physicians and family to know that this is your wish.

I’m Worried About Pain, but I Don’t Want to Be Hooked up to Machines if I Have a Terminal Condition. Should I Have an Advance Directive?

Yes. No matter what you choose about life-prolonging treatment, you will be treated for pain and kept comfortable.

Will I Get Less Respect and Medical Attention if I Do Not Want to Have Life-Prolonging Treatment?

No. Your physicians and nurses may not discriminate against you based on your healthcare choices. You will get whatever care is appropriate, but you will not get any treatment that you have stated you do not want.

Can My Spouse Be One of My Two Witnesses? What About Other Blood Relatives?

Yes, your husband/wife can be your witness. Other blood relatives can also be witnesses as long as they are adults.

Can My Agent Be a Witness?

Yes, but to avoid the chance of conflict, it is better to have someone who is not your agent (or your alternate agent) be a witness.

Does an Advance Directive in Virginia Need to Be Notarized?

No.

Are Copies of Advance Directives Valid?

Yes.

I Have a Financial Power of Attorney. Does It Cover Healthcare Decisions?

Probably not. It is better to have a separate healthcare power of attorney document. If you are in doubt, consult a lawyer or ask at a hospital.

Can My Family or Physicians Override My Decisions if I Am Unable to Speak for Myself?

No. This is one of the major reasons to create an Advance Directive.

Will My Virginia Advance Directive Be Valid in Other States?

It should be. Just as Virginia honors Advance Directives properly executed in other states, most states have similar rules to honor out-of-state Advance Directives. Nevertheless, if you spend a considerable amount of time in another state, you may want to have an Advance Directive executed for that state as well. You may also want to register your Advance Directive with an online registry, such as US Living Will Registry.

Where Should I Keep My Advance Directive? Who Gets Copies?

Just as important as creating an Advance Directive is making sure that other people know that you have it and know where it is located. Specifically, you should:

• Give a copy or the original to your agent or proxy.
• Give a copy to your physician(s).
• Give a copy to family and friends.
• Bring it to the hospital with you.
• Register a copy at Connect Virginia, and make sure your agent or proxy has access.

Additionally, you should keep a copy of your Advance Directive in a safe place where it can be found easily. Do not keep your only copy in a lock box or safe.

Does It Cost Anything to Create an Advance Directive?

No. Free forms are linked at the top of this page.

Do I Need a Lawyer to Draft an Advance Directive? Must I Use These Forms?

A lawyer is not required to draft a valid Advance Directive. There are free forms available at the links above, but a lawyer may help you if you have questions or complex healthcare needs. The free forms are also only models. You can use them or numerous other forms or no form at all. Just be sure that whatever you use includes: (1) your healthcare wishes, (2) your signature, and (3) the signatures of two adult witnesses.

What Is a Do Not Resuscitate (DNR) Order?

A DNR is a doctor's order saying that you will not get CPR, drugs, or electric shock to restart your heart or breathing if your heart stops or you stop breathing. A Durable Do Not Resuscitate Order (DDNR) is a special DNR order that your doctor can provide you so that EMS, fire, and rescue and any healthcare provider will know your wishes about resuscitation. Note: copies of DDNR forms are now valid in Virginia, and DDNR forms may be downloaded (to bring to your physician) at the Office of Emergency Medical Services website.

Can My Advance Directive Provide Organ Donation Wishes?

Yes. Your advance directive may provide organ donation and other anatomical gift wishes.

Advance Care Planning Items to Download and Print

• Conversation Starter Kit
• How to talk to your doctor
• Choosing or being a healthcare proxy
• Alzheimer's/Dementia Starter Kit
• Pediatric Starter Kit
• American Hospital Association’s Wallet ID Card

National Healthcare Decisions Day

Have You Thought About the Type of Care and Medical Treatment You Might Want Should You Ever Become Unable to Make Decisions or Speak for Yourself?

It’s hard for most of us to imagine this scenario. However, you never know when you may experience a medical emergency. Advance Care Planning is making decisions about the healthcare you would want to receive if you’re facing a medical crisis. These are your decisions to make based on your personal values, preferences, and discussions with your loved ones. Advance Care Planning helps you prepare for the unexpected while you are well and able to make difficult decisions for yourself.

April 16th is National Health Care Decisions Day. Mary Washington Healthcare, along with other community, state, and national organizations, is leading an effort to raise awareness of the importance of advance healthcare decision‐making. National Healthcare Decisions Day encourages all adults in the U.S. to consider their healthcare wishes. The day hopes to inspire, educate and empower the public and providers about the importance of advance care planning.

Mary Washington Healthcare is here to help. If you need assistance in completing an Advance Directive or have questions about Advance Care Planning please call Mary Washington Healthcare Patient Relations Department 540.741.3955

Additional Resources and Helpful Links

• Virginia Advance Directives
• Virginia Healthcare Decisions Act
• The Conversation Project
• Connect Virginia - Virginia Advance Health Care Directives Registry
• Aging with Dignity - Five Wishes
• National Hospice and Palliative Care Organization
• American Bar Association’s Toolkit for Health Care Advance Planning
• National Institute on Aging
• Prepare For Your Care