Advance Care Planning: Frequently Asked Questions
What is an Advance Directive?
This is any declaration that a person makes about their wishes for medical treatment in advance of their inability to speak for themselves. A written Advance Directive form in Virginia usually includes naming a Healthcare Agent, wishes for general healthcare and for end-of-life care, and instructions for organ and tissue donation. In order to be legally valid, a written Advance Directive must be signed and two witnesses must also sign.
What is the Health Care Decisions Act?
The law in Virginia states that all adults of sound mind "have a right to determine what shall be done with his [or her] own body." The Health Care Decisions Act provides specific directions on how Advance Directives are to be created and honored. You can read the Health Care Decisions Act by going to www.virginia.gov and searching for Health Care Decisions Act.
Do I need an attorney to write an Advance Directive?
No. You can write your own Advance Directive, but some attorneys are able to provide guidance. If you are managing a chronic illness, it is best to talk with your doctor so that you can include the kinds of decisions that might apply to you.
Does the form have to be notarized?
No. In Virginia, two witnesses over the age of 18 are required; if it is notarized, there must also be another witness' signature.
How can I revoke or change my Advance Directive?
It is best to destroy old copies and create a new Advance Directive. You can revoke an Advance Directive by destroying it or crossing through all pages and writing "Revoked" with your signature and date.
How can I be sure that my Advance Directive
will be honored?
Advance Directives are only used if you are not able to speak for yourself. Your Healthcare Agent will become your advocate if this happens. In an emergency situation, it is usually not clear to doctors if you might be able to recover, so they may begin treatments until your prognosis is clearer.
If I don't want CPR, will this be honored?
Only a physician can order that CPR not be performed. This is called a "Do Not Resuscitate" (DNR) order. If your Advance Directive says that you do not want CPR in the event that you have a terminal illness, a doctor in the hospital can write this order. If you are at home, your doctor can write this order on a special form that is recognized and honored by emergency responders and other doctors. If you want to have such an order in place now, discuss it with your doctor.
What is a Living Will?
People often use this term interchangeably with Advance Directive, but it means the portion of your Advance Directive that specifies your wishes for end-of-life medical care.
What are "life-prolonging treatments?"
In Virginia, this term includes artificial nutrition, IVs for hydration, ventilation (breathing machine) and cardiopulmonary resuscitation (CPR). You can use your Advance Directive to make specific wishes about each of these treatments, but it is important to tell your Healthcare Agent what results you would want if they were provided.
What is CPR?
This is cardio (heart) pulmonary (lungs) resuscitation (starting something that has already stopped). Chest compressions are used to stimulate the heart, and air is forced into the lungs. In the hospital and when 911 is called, drugs are injected, electric shock may be used and a tube is inserted into the throat so that a machine can breathe for the person.
How can I decide if I want CPR or not?
This is different for everyone, and it depends on your personal values combined with your medical condition. When it is used in people who are in the late stages of an illness or who are frail with chronic illnesses, the success rate is much lower. Even when successful in these people, recovery may not be complete and they could require 24-hour nursing care or could be dependent on a breathing machine. If you are considering this question, it is best to talk with your doctor about the likely outcomes in your own situation.
What is a "terminal condition?"
Most Advance Directives state that certain treatments should or should not be provided if two doctors certify that you are in a terminal condition. As defined in Virginia, this means a condition from which you are unlikely to recover and death is imminent, or you are in a persistent vegetative state (PVS). Your own wishes for treatment may be different if you are either terminally ill or in a persistent vegetative state. You can use your Advance Directive to be specific about these choices.
What is a "persistent vegetative state?"
Someone who is in a persistent vegetative state is not aware of themselves or their surroundings, has no movements other than reflexes, and recovery is not expected.
This is overwhelming. How can I decide?
No one can foresee exactly what is going to happen to them at the end of life. The best you can do is talk with the people who are close to you about what makes life worth living, and what conditions you think make it too burdensome to continue. Chances are you will change your opinions over time, and as you see others' experiences. Take any opportunity to talk about these issues. These are hard but important things to talk about. Enlist the help of your doctor or call us if you are struggling.