Advance Care Planning

Planning for the Future of Your Care

Have you ever considered the kind of care and medical treatment you'd prefer if you were ever unable to communicate your wishes or make decisions for yourself?

It can be challenging to contemplate such scenarios, particularly when we are young and in good health. However, unexpected medical emergencies, like car accidents or sudden illnesses, can happen to anyone, and being prepared is important.

Making Choices for Your Healthcare in Advance

Advance care planning involves deciding on the medical care you'd want in case of a health crisis. These decisions are based on your own values, preferences, and conversations with your loved ones. It's a way to get ready for the unexpected while you're still in good health and able to make challenging choices for yourself.

Advance care planning involves:

Gathering information about available life-sustaining treatments.
Making choices about the treatments you'd prefer or would not want if faced with a life-limiting illness.
Communicating your personal values with your loved ones.
Recording your treatment preferences in writing and designating a spokesperson in case you can't communicate your wishes.

Surprisingly, while 82% of people recognize the importance of documenting their wishes, only 23% have taken the step to do so.

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 cannot make decisions for yourself, 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. The person you designate in this second type of decision is granted the authority to make decisions in line with what you would have chosen if you were able. In some cases, you can set specific boundaries on the decisions the appointed person is allowed to make.

It's important to note that the law prohibits the person you choose from making decisions that go against your religious beliefs, core values, or 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, passed by Congress in 1990, requires that healthcare institutions inform their patients and communities about their rights regarding medical care decisions. These rights encompass accepting care, refusing care, and creating advance directives for their healthcare.

What are Advance Directives

Advance Directives are legal documents that allow you to express your medical preferences in writing and designate a trusted individual to make healthcare decisions on your behalf. These documents provide reassurance that, in case of unforeseen circumstances, your wishes are clearly stated.

Additionally, preparing an Advance Directive is a valuable gift to your loved ones. It eases their burden by ensuring that medical decisions align with your desires, granting them peace of mind during difficult times.

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 Explained

A Living Will is a written document that outlines your preferences for medical care in case you can't communicate your wishes due to a severe illness or accident.

It covers decisions regarding various medical treatments, such as:

CPR (to restart your heart if it stops)
Breathing tube (mechanical ventilation)
Kidney dialysis (if your kidneys fail)
Artificial hydration or nutrition

It's important to note that a Living Will is different from a Last Will & Testament, which focuses on how you want your assets and property to be distributed after your passing.

Medical Power of Attorney / Healthcare Agent Explained

A Medical Power of Attorney gives a trusted person the legal power to make decisions on your behalf if you're unable to do so.

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

Selecting the right person to serve as your healthcare agent is crucial. Even if you have other legal documents related to your care, not all circumstances can be predicted, and some situations may require someone to exercise judgment regarding your likely care preferences. When choosing a healthcare agent, consider these 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

Your chosen person could be a spouse, another family member, friend, or a member of your faith community. You may also designate one or more alternates in case your initial choice is unable to fulfill the role.

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

Optional Documents (including DNRs)

You don't necessarily need an advance directive or living will to have orders like Do Not Resuscitate (DNR) or Do Not Intubate (DNI). To establish DNR or DNI orders, simply inform your doctor of your preferences. They will then write these orders and include them in your medical record.

Even if you already possess a living will that specifies your preferences regarding resuscitation and intubation, it's advisable to establish DNR or DNI orders every time you enter a new hospital or healthcare facility.

Here's a breakdown of these orders:

Do Not Resuscitate (DNR): This means not attempting to revive your heart if it stops or beats irregularly while you're in the hospital.
Do Not Intubate (DNI): No use of a breathing machine if you can't breathe on your own.
Durable Do Not Resuscitate (DDNR): A specialized DNR order that your doctor can provide. It ensures that EMS, fire, rescue teams, and healthcare providers are aware of your resuscitation preferences. Copies of DDNR forms are now valid in Virginia and can be downloaded from the Office of Emergency Medical Services website (to be shared with your physician).
Physician Order or Medical Order for Life-Sustaining Treatments (POLST or MOLST): These physician orders are intended for individuals already diagnosed with a serious illness. They don't replace your other directives but serve as doctor-ordered instructions, akin to a prescription. Your doctor completes the form based on your advance directives, discussions about your illness prognosis, and treatment preferences. The POLST/MOLST stays with you and is posted near your bed in a hospital or nursing home, or prominently displayed in your home or hospice facility for easy access by emergency personnel or healthcare teams.
Organ and Tissue Donation: This involves granting permission to donate your organs in the event of your passing.

Taking Action

Create a Living Will and Medical Power of Attorney (MPOA)
Keep your documents in a secure but easily 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

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 if 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

National Healthcare Decisions Day

Have you ever considered the kind of care and medical treatment you'd prefer if you were ever in a situation where you couldn't make decisions or communicate your wishes?

It's not easy to think about, but unexpected medical emergencies can happen to anyone. Advance Care Planning involves making decisions about the healthcare you'd want in such a crisis. These decisions are entirely yours and should reflect your personal values, choices, and conversations with your loved ones. Advance Care Planning allows you to prepare for the unexpected while you are still in good health and capable of making tough decisions.

April 16th marks National Health Care Decisions Day. Together with various community, state, and national organizations, Mary Washington Healthcare is taking the lead in raising awareness about the significance of advanced healthcare decision-making. National Healthcare Decisions Day encourages all adults in the U.S. to reflect on their healthcare preferences. The aim is to inspire, educate, and empower both the public and healthcare providers regarding the importance of advance care planning.

Additional Resources and Helpful Links

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