Medical Decisions / Advance Directives

Patient Self-Determination Act
Summary of Policy Statement

In accordance with North Carolina law, Catawba Valley Medical Center is providing information concerning the Patient Self Determination Act of 1990 and the Advance Instruction for Mental Health Treatment Act of 1997 to all patients admitted to the medical center.

Catawba Valley Medical Center supports the competent adult’s right to make decisions regarding the acceptance or refusal of medical, surgical or mental health treatment in accordance with North Carolina laws.

All patients will be asked if they have advance directives. The patient’s response will be documented in his or her medical record. Information will be provided for each inpatient at Catawba Valley Medical Center.

In order to implement a patient’s advance directive, Catawba Valley Medical Center has made the following provisions:

  • When a copy of the patient’s advance directive is provided, the admitting nurse will place it in the patient’s chart.
  • If a copy of the patient’s advance directive is not available, the admitting nurse will complete an Advance Directive Summary and place it in the patient’s chart.
  • The attending physician will be notified of the existence of the advance directive immediately upon admission.
  • The advance directive will be prominently placed in the patient’s chart along with an advance directive sticker, which will inform all medical personnel and medical center staff about the existence of the document.

MEDICAL CARE DECISIONS AND ADVANCE DIRECTIVES
WHAT YOU SHOULD KNOW

Who decides about my medical care or treatment?

If you are 18 or older and mentally competent, you have the right to make decisions about your medical treatment. You should talk to your doctor or other health care provider about any treatment or procedures so that you understand what will be done and why. You have the right to say yes or no to treatments recommended by your doctor. If you want to control decisions about your health care, even if you become unable to make or express them yourself, you will need an “advance directive.”

What is an “advance directive?”

An advance directive is a set of directions you give about the health care you want if you lose the ability to make the decisions for yourself. There are three ways for you to make your directions known:
1. Living Will
2. Health Care Power of Attorney.
3. Advance Instruction for Mental Health Treatment

Do I have to have an advance directive, and what happens if I don’t?

Making a living will, appointing a health care power of attorney or making an advance instruction for mental health treatment is your choice. If you become unable to make your own decisions and you have no living will or a person named to make medical care decisions for you (health care agent), your doctor or health provider will consult with someone close to you about your care.

What is a living will?

In North Carolina, a living will is a document that tells others what care you want to receive if you are (1) terminally and incurably sick or (2) in a vegetative state in which you will not recover. In a living will, you can direct your doctor not to use heroic treatment that would delay your dying, for example by using a breathing machine (respirator or ventilator), or to stop such treatments if they have been started. You can also direct your doctor not to begin or to stop giving you food and water through a tube (artificial nutrition or hydration).

What is a health care power of attorney or health care agent?

In North Carolina, you can name a person to make medical care decisions for you if you later become unable to decide for yourself. This person is called your “health care agent.” In the legal document you name who you want your agent to be. You can say what medical treatments you would want and what you would not want. Your agent then knows what choices you would make. Your health care agent may also be designated in a Durable Power of Attorney document.

How would I choose a health care agent?

You should choose someone you trust. Discuss your wishes with that person before you sign the power of attorney form. The person chosen must be mentally competent and at least 18 years of age.

What is an advance instruction for mental health treatment and an attorney-in-fact?

Advance instruction for mental health treatment means a written instrument, signed by two qualified witnesses, that makes a declaration of instructions that also provides information and preferences regarding mental health treatment, appoints an attorney-in-fact and continues in effect for a period of two years. An attorney-in-fact means an adult appointed to make mental health treatment decisions for a person under an advance instruction for mental health treatment. An advance instruction for mental health treatment may be combined with a health care power of attorney.

HOW DO I MAKE AN ADVANCE DIRECTIVE?

You must follow several rules when you make a formal living will, appoint a health care power of attorney, or make an advance instruction for mental health treatment. These rules are to protect you and ensure that your wishes are clear to the doctor or other provider who may be asked to carry them out. Your directives must be written and signed by you while you are able to understand your condition and treatment choices and to make those choices known. All types of advance directives must be witnessed by two qualified people and be notarized. Medical center staff members cannot be used as witnesses. We will provide a notary should you wish to make an advance directive while a patient here.

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

Yes. These forms meet all of the rules for a formal advance directive. Using the special form is the best way to make sure that your wishes are carried out.

WHEN DOES AN ADVANCE DIRECTIVE GO INTO EFFECT?

The powers granted by your health care power of attorney go into effect when your doctor states in writing that you are not able to make known your health care choices. When you sign a health care power of attorney, you may name the doctor you would want to make this decision. A living will goes into effect when you are going to die soon and cannot be cured or when you are in a persistent vegetative state. An advance instruction for mental health treatment goes into effect when you lack the capacity to make and communicate mental health treatment decisions for yourself.

WHAT HAPPENS IF I CHANGE MY MIND?

You can cancel a living will both by destroying all the copies of it and by informing your doctor that you want to cancel it. You can change your health care power of attorney or attorney-in-fact by destroying all the signed copies or signing another one, and by telling your doctor and each health care agent about the change.

COMMUNICATING YOUR WISHES

Who to talk with about an advance directive?

You should talk to those closest to you about an advance directive and your feelings about the health care you would like to receive. Your doctor or healthcare provider can answer medical questions. A lawyer can answer questions about the law. Some people also discuss the decision with clergy or other trusted advisors.

Where should I keep my advance directive?

Keep a copy in a safe place where your family members can get it. Give copies to your family, your doctor or other healthcare provider, your healthcare agent, your hospital of choice and any close friends who might be asked about your care should you become unable to make decisions.

You may want to register your advance directive free with the U.S. Living Will Registry by calling 1-800-584-9455. In addition, for a small fee you may register your advance directive with the North Carolina Secretary of State’s Office in Raleigh, NC. For more information call 1-919-807-2000.

What if I have an advance directive from another state?

An advance directive from another state may not meet all of North Carolina’s rules. To be sure about this, you may want to make an advance directive in North Carolina too. Or, you could have your lawyer review the advance directive from the other state.

Where can I get more information?

You can get more information about advance directives by contacting the following departments at Catawba Valley Medical Center:

  • Spiritual Care at (828) 326-3365
  • Clinical Resource Management at (828) 326-3895

Note: This document has been developed with information provided by the North Carolina Division of Medical Assistance in cooperation with the North Carolina Department of Human Resources Advisory Panel on Advance Directives.