Advance Medical Directives (AMD)
At Charleston Area Medical Center, we respect your right to accept or refuse any medical or surgical treatment.
Many of us may be unable to give informed consent or to refuse treatment at some time in our lives. However, temporary or even permanent inability to decide for ourselves need not cause us to lose all control over our health care. We can create an advance directive (living will or medical power of attorney) to help us stay in charge of our own treatment beyond the point we become incapacitated.
It is our policy to honor advance directives and we encourage you to have one. However, we do not require you to have signed an advance directive. If you would like to execute an advance directive, we can help. It's free and you do not need a lawyer. Just tell any CAMC nurse or physician that you want assistance.
Why are advance directives for health care decision making so important?
As an adult, you have the right to make your own health care decisions. You may expect your doctor and other health care providers to tell you about the nature of any proposed procedure or treatment, its probable benefits or effects, and any predictable discomfort, complications or risks.
You have the right to know alternative treatments, their risks and benefits. You have the right to ask questions, and you have the right to decide whether you want the treatment. Your right to accept medical or surgical treatment also includes the right to refuse it.
What if, because of injury or illness, you become incapable of making health care decisions for yourself?
For example, imagine you are in a hospital, terminally ill with cancer and are confused. Who decides whether you are resuscitated if your heart stops suddenly? Or what if you are 40 years old and are involved in a motor vehicle accident which leaves you permanently unconscious? Who decides whether you should be kept alive with tube feedings? Or what if you have Alzheimer's disease, live in a nursing home and you develop a serious infection? Who decides whether you will be hospitalized and treated with antibiotics?
Even if you cannot decide for yourself, you can remain in charge of your health care by creating a document called an advance directive.
West Virginia law recognizes two types of written advance directives for health care decision making: the living will and the medical power of attorney. You can use these documents to let your family and doctor know your decisions for health care if you become disabled or incapacitated. You can appoint someone you know and trust as your health care representative to ensure that your choices or decisions are honored.
Decisions about the type of treatment you would want in the future can be difficult to make. Before you create either a living will or medical power of attorney, you may find it helpful to discuss your health care preferences and options with your family, friends, doctor or religious counselor.
Frequently asked questions about Advance Medical Directives
A living will is a document that directs your doctor to withhold or withdraw life-prolonging interventions (such as cardiopulmonary resuscitation, kidney dialysis or machines to help you breathe) if you are terminally ill or in a persistent vegetative state (permanently unconscious). It tells your doctor to provide only those treatments that will relieve pain and provide comfort. You may add other special directives or limitations in your living will.
A medical power of attorney is another type of advance directive which allows you to name a person to make health care decisions for you if you are unable to make them yourself.
A living will only applies if you are terminally ill or in a persistent vegetative state, and, unless you write in other specific instructions, it only tells your doctor what you do not want.
The medical power of attorney allows you to appoint someone to make health care decisions for you if you cannot make them. It covers all health care situations in which you are incapable of making decisions for yourself. It also allows you to give specific instructions to your representative about the type of care you would want to receive.
The medical power of attorney allows your representative to respond to medical situations that you might not have anticipated and to make decisions for you with knowledge of your values and wishes.
Since the medical power of attorney is more flexible, it is the advance directive most people choose. Some people, however, do not have someone whom they trust or who knows their values and preferences. These people should consider creating a living will.
Advance directives are for all persons, 18 years or older. We never know when an accident or serious illness will leave us incapable of making our own health care decisions.
It is not uncommon for people to create both a medical power of attorney and a living will. Since the medical power of attorney is a more flexible document and allows you to name someone to make decisions for you, it is advisable to create a medical power of attorney even if you have a living will. The representative you appoint with your medical power of attorney can help see that the preferences expressed in your living will are carried out.
If you choose to sign both documents, you should see that they are stored in the same place to help assure that your representative will know to respect all of your wishes.
Yes. You have the right to make your own health care decisions as long as you are able to do so. Your advance directive becomes effective only when you are incapable of expressing your own preferences.
Choose someone who knows your values and wishes, and whom you trust to make decisions for you. Do the same for a successor representative. Ask both to be sure they understand and agree to be your representative.
Your representative may be someone who will inherit from your estate. You may, but do not have to, choose a family member to be your representative. Regardless of your choice, your representative should be someone who is likely to be available if needed and who will decide matters the way you would decide.
Name only one person each as your representative and your successor representative. Do not choose your doctor, or another person who is likely to be your future health care provider, as your representative or successor representative.
You may give very general instructions and preferences, or be quite specific. Although not required, it would be helpful to your representative to have specific directions from you about life-prolonging interventions, particularly cardiopulmonary resuscitation (CPR), artificially-supplied food and water (tube feedings), the use of machines to help you breathe, and organ and tissue donation.
Many people choose to write their representative a letter stating their personal values and wishes, their feelings about life and death and any specific instructions. They attach a copy of this letter to their medical power of attorney.
Any person 18 years of age or older who has the capacity to make decisions for himself or herself can create an advance directive.
No. Both the medical power of attorney and living will can be created without the assistance of a lawyer.
The qualifications for the witnesses are printed on both forms. Your witnesses must be at least 18 years of age and not related to you by blood or marriage. Choose people as witnesses who will not inherit any of your property. Do not choose your representative, your successor or your doctor as your witness.
After your advance directive is signed, witnessed and notarized, give one copy each to your representative, to your successor representative and to your doctor. Keep the original document in a safe location where it can be easily found. Your safety deposit box may not be the best place for your advance directive unless you are certain someone close to you has access to the safety deposit box if you become incapacitated. Make sure your representative knows where the original is so it can be shown to your doctor on request. However, a photocopy of your advance directive is legally valid.
Consent to and refusal of health care is your right. If you have made your wishes known in an advance directive, your doctor and your representative must respect those wishes. If your doctor cannot comply with your wishes, he or she must transfer your care to another doctor.
If you have appointed someone as your representative under a medical power of attorney, that person's consents and refusals on your behalf are as meaningful and valid as your own. The wishes of other family members do not override your own clearly expressed choices or those made by your representative on your behalf.
No doctor or other health care provider may require creation of an advance directive as a condition for you to receive services.
Laws differ somewhat from state to state, but in general, a patient's expressed wishes will be honored. No law or court has invalidated the concept of advance directives, and an increasing number of statutes and court decisions support it.
You should review your advance directive periodically to make sure it reflects your wishes. The best way to change your advance directive is to create a new one. The new advance directive will automatically revoke the old version. Be sure to notify all people who have copies of your advance directive that you completed a new one. Collect and destroy all copies of the old one.
Be sure your doctor has a current copy. Bring a copy with you if you are admitted to a health care facility. Tell people, especially your representative and other family members, where you keep your advance directive.