Speak for Yourself! Making Your Future Health Care Decisions The future depends on what we do in the present. –Mahatma Gandhi

The Facts 29% of West Virginians have been involved in making medical decisions for a family or friend in their last days 48% have both a Living Will and a Medical Power of Attorney 72% would choose to live a shorter time to avoid pain and suffering

More Facts 55% of West Virginians agree it is important to talk with their family and doctor about how they want to be treated at the end of their life 72% have talked with a family member or close friend 26% have talked with their doctor 67% prefer to die at home HOWEVER 57% die in a hospital or nursing facility

Why have “the conversation?” The time may come when certain treatments offer little or no benefit or may actually be harmful. Enables you to decide on the kind of care you want at the end of your life Assures you that your wishes will be carried out if you are unable to make decisions for yourself A true gift to your loved ones—relieves your family of the difficult burden of trying to decide what you might want

Steps to having a conversation Step 1: Get Ready! Step 2: Get Set! Step 3: Go! Step 4: Keep going!

Step 1: Get Ready You don’t need to talk just yet. Take your time. Think about it. Start by writing a letter to yourself or a loved one. Think about having a practice conversation with a friend.

Step 2: Get Set Think about what you want for the end of your life. Consider all the “what ifs” – heart attack, stroke, cancer What matters to me is ______? Do I want to live as long as possible no matter the cost? Quality of life is more important than quantity of life. I wouldn’t mind going to a nursing home. Living independently is huge. I don’t want my loved ones to know everything about my health. Talk with your physician Read “Hard Choices for Loving People”

Step 3: Go GO FOR IT! Who do you want to include in the conversation? When would be a good time to talk? Where would you feel comfortable talking? What do you want to be sure to say? Remember – You don’t have to cover everything in the first conversation. This is a process. You can change your mind. A “good death” means different things to different people and your loved ones may disagree with your choices. That’s OK. They are your choices. GO FOR IT!

Step 4: Keep Going Now is the time to put your conversation in writing with an advance directive

Types of Advance Directives In West Virginia there are several types of Advance Directives: Living Will Medical Power of Attorney DNR (Do Not Resuscitate) POST (Physician Orders for Scope of Treatment)

Traditional Advance Directives Living Will or Medical Power of Attorney For future healthcare decisions (What you would want if . . . ) Cannot address all the possible circumstances

Actionable Advance Directives DNR and POST Put into effect immediately Decisions based on current health status and present options for care Clearly defined (black and white)

Living Will A statement of your wishes if you are terminally ill or permanently unconscious and heroic measures are being considered or have been started Only applies to the above-mentioned circumstances Is a plan for the future

Medical Power of Attorney Enables you to name a person to make health care decisions for you if you are unable to make them for yourself Applicable in any health care situation where you are incapacitated When you recover, you resume responsibility of your own care Is a plan for the future

Do Not Resuscitate (DNR) Doctor’s order Takes effect immediately Protects a person’s right to not have CPR For people for whom CPR would not be helpful (chronically or terminally ill, frail, advanced age)

The POST Form Used for: Seriously ill patients (chronic, progressive disease) Terminally ill patients The frail elderly Doctor’s order Takes effect immediately Goes with the patient where ever he or she goes – home, hospital, nursing home Easy to read, easy to find Assures a patient’s end-of-life care wishes will be honored Can be completed for a patient by the MPOA or Health Care Surrogate

When There is No Directive: Health Care Surrogate When the patient is unable to make a medical decision and there is no MPOA in place, the physician may appoint a Health Care Surrogate The Health Care Surrogate makes all medical decisions for the patient. Selection based on a priority order, but physician discretion is allowed

Guardianship When there is no LW or MPOA and no appropriate person to appoint as HCS, a guardian is appointed by the courts to make medical decisions. There is a cost involved. It may take weeks to work through the guardianship process.

MPOA / Durable POA Medical Power of Attorney is only for medical decisions. Durable Power of Attorney is only for legal, financial or business decisions but may have a “health care decisions” clause. May have two different people or the same person as MPOA/POA

COMMONLY ASKED QUESTIONS ABOUT ADVANCE DIRECTIVES

Who Should Have an Advance Directive? Advance directives are for any one over the age of 18 including emancipated and mature minors.

If I already have a Living Will, do I need a Medical Power of Attorney? Most West Virginians have both. MPOA is more flexible. Those who do not have someone to act as MPOA should consider creating a LW.

Can I still make my own decisions once I have created an advance directive? Yes, your advance directive does not become effective until you are incapable of clearly expressing your own wishes. (Incapacity is determined by a physician, psychologist or advanced practice nurse.)

Do I need a lawyer to create an advance directive? No, but both documents must be signed and witnessed in the presence of a Notary Public. Witnesses must be 18 years of age and not related to you by blood or marriage.

What do I do with my advance directive? After it is signed, witnessed and notarized: Give a copy to – Your representative (who should know where the original copy is) Your successor representative Your doctor Your local hospital Keep the original in a safe place that is easily located – not your safety deposit box!

What if my doctor or loved ones disagree with my decisions? Communication is the key! You can prevent confusion by talking with loved ones about your personal values and beliefs. Remember that these decisions are yours, and they must be carried out by health care providers. If a doctor cannot comply, he or she must transfer your care to another doctor.

Will another state honor my advance directive? Laws differ from state to state, but in general a patient’s expressed wishes will be honored.

Will my advance directive from another state be honored in WV? West Virginia will honor other states advance directives as long as they are validly completed according to that states laws or WV law. But if you are a WV resident you should complete a WV advance directive. If you live in a bordering state and get the majority of your health care in WV, you can complete a WV advance directive.

What if I change my mind about my representative or treatment? Review your advance directive periodically (tax time.) Create a new one if necessary. Collect and destroy all old copies. Be sure to tell your loved ones about changes. The document with the most recent date is the one that will be followed.

Can I write my wishes for funeral arrangements on my Advance Directive? Yes, but you must include this sentence in the Special Directives section: “I authorize my representative to make decisions regarding my funeral arrangements or cremation.”

WV e-Directive Registry Through a password protected secure system, will make your advance directive or medical orders available to treating health care professionals in the case of an emergency and your documents can’t be located. After you have completed the forms FAX them to:

To obtain current advance directive forms call: 877-209-8086 or go to www.wvendoflife.org