1. H EALTH C ARE A DVANCE D IRECTIVES : H EALTH C ARE P OWERS OF A TTORNEY AND L IVING W ILLS S ONNY S. H AYNES

2. A GENDA 2 Why do we have health care advance directives? Two types of advance directives: Health Care Powers of Attorney and Living Wills The purpose of each When they are valid When they are effective How the documents work together The Advance Directive for North Carolina

3. T HE C ONCEPT B EHIND H EALTH C ARE A DVANCE D IRECTIVES 3

4. 4 T HE H EALTH C ARE P OWER OF A TTORNEY (HCPOA)

5. 5 T HE HCPOA IN GENERAL A specific kind of power of attorney Patient appoints a health care agent Agent makes the patient’s healthcare decisions when the patient cannot

6. W HEN IS THE HCPOA VALID ? Written document –Statutory form –Easy-to-read form Signed and dated by patient of “sound mind” –Understands the implications of the document In the presence of two qualified witnesses Acknowledged before a notary public 6

7. W HEN IS THE HCPOA EFFECTIVE ? The HCPOA is only effective when the patient lacks capacity to make or communicate health care decisions. 7

8. W HEN D O P ATIENTS L ACK C APACITY TO M AKE H EALTH CARE D ECISIONS ? When a judge has declared the patient incompetent and appointed a guardian or When a doctor says the patient cannot make or communicate his/her own health care decisions 8

9. W HAT K INDS OF H EALTH C ARE D ECISIONS C AN THE A GENT M AKE ? This will depends on what the patient wants –Can be broad authority (any decision the patient could make) –Can be limited or restricted 9

10. S PECIFIC P OWERS G RANTED Right to consent, or refuse consent, for medical treatment and diagnostic procedures Choosing medical providers Access to medical records To direct disposition of remains, donate organs, authorize an autopsy Decisions about mental health treatment Authorize starting or stopping life- prolonging measures 10

11. W HAT A RE L IFE -P ROLONGING M EASURES ? Procedures or interventions that only artificially postpone death by sustaining, restoring, or supplanting a vital function –Includes mechanical ventilation, dialysis, antibiotics, artificial nutrition and hydration, etc. Life-prolonging measures do not include care necessary to provide comfort or to alleviate pain 11

12. L IVING W ILLS 12

13. L IVING W ILLS I N G ENERAL More limited scope than the HCPOA Includes patient’s wishes for whether to withhold or withdraw life-prolonging measures When the patient lacks capacity and the patient’s condition meets certain criteria 13

14. W HEN IS A L IVING W ILL VALID ? Written document –Statutory form Signed and dated by patient of “sound mind” In the presence of two qualified witnesses Acknowledged before a notary public 14

15. W HEN IS A LIVING WILL EFFECTIVE ? Patient lacks capacity Patient’s condition meets the criteria in the Living Will 15

16. C RITERIA IN THE S TANDARD L IVING W ILL F ORM Incurable or irreversible condition that will result in death within a relatively short period of time; or Unconscious and, to a high degree of medical certainty, will not regain consciousness; or Suffers from advanced dementia or any other condition with substantial loss of cognitive ability that, to a high degree of medical certainty, is not reversible. 16

17. M AY VS. S HALL AND THE “O PT - IN ” O PTION The statutory form allows patients to choose between whether life-prolonging measures “may” or “shall” be withheld or withdrawn The easy to read form does not have this option The “opt-in” option Special choice for artificial nutrition/ hydration: the patient may also choose not to have life-prolonging measures but elect to receive artificial hydration and/or nutrition 17

18. W HAT HAPPENS IF THERE IS NO LIVING WILL ? Life-prolonging measures may be withheld if the patient lacks capacity to make or communicate health care decisions and will never regain that capacity – if: –The patient’s condition must be confirmed in writing by another physician –A vital bodily function must be sustained by life- prolonging measures –Appropriate consent is required 18 Patient has an incurable or irreversible condition that will result in the death within a relatively short period of time; or Patient is unconscious and, to a high degree of medical certainty, will never regain consciousness.

19. H OW HCPOA’ S AND L IVING W ILLS W ORK T OGETHER 19

20. D OES THE PATIENT NEED BOTH DOCUMENTS ? Some things to consider: –How strong are the patient’s feelings about end-of-life care ? –Will the health care agent follow the patient’s wishes? –Will written evidence of the patient’s wishes help the family? Important points if both documents are used: –Make sure the documents are consistent –The patient should decide whether to allow the health care agent to override his/her Living Will or not 20

21. A DVANCE D IRECTIVE (E ASY - TO -R EAD F ORM ) Complies with North Carolina law: (N.C. Gen. Stat. §§ 32A-15 through 32A-27 and §§ 90-320 through 90-322). Three parts: –Part A – Health Care Power of Attorney –Part B – Living Will –Part C – Acknowledgment and Execution 21

22. A DVANCE D IRECTIVE P ART A – T HE HCPOA  Key Points: −Form only allows for appointment of one agent at a time −Cross through Section 2 if the patient has no Special Instructions −Must initial to authorize organ donation 22

23. A DVANCE D IRECTIVE P ART B – T HE L IVING W ILL  Key Points: −Cross through Part B if the patient does not want a Living Will −Select conditions −Special provisions for tube feeding −Pain management will not be withheld −Indicate whether health care agent can override Living Will 23

24. A DVANCE D IRECTIVE P ART C – S IGNATURE AND A CKNOWLEDGMENT  Witnesses cannot be related to the patient or employed by the health care facility  Notarization required 24

25. 25 Got Plans 123 Got Plans 123

26. 26 Questions?