Advance Directives + -

The Federal Patient Self-Determination Act requires hospitals to ask all admitted patients if they have an advance directive, such as a "Living Will" or a "Durable Power of Attorney," that would affect decisions regarding their medical treatment. If you would like more information about this Federal law, or the Virginia Natural Death Act, please ask your nurse for a free booklet.

Below is a list of terms and frequently asked questions that can help you as you fill out your advance directive. If you need further assistance, please consult your physician.

Advance directive – A written document that outlines your health care wishes if you are no longer capable of making those wishes known. This can be accomplished through a living will, durable power of attorney for health care, request for organ donation or other documents. The document can be changed whenever you like, as long as you are capable of doing so.

Comfort care – Care that keeps you comfortable but does not treat the illness. This could be pain control, bathing, bed turning and lip moistening.

Terminal illness – An illness that has no cure, even with medical treatment. Generally, a person who has a terminal illness is someone who is not expected to live longer than six months. In a terminal illness, life sustaining treatments prolong the dying process, not stop it.

Artificial nutrition/hydration – Food and water given through a tube to those who cannot eat or drink enough to sustain themselves.

CPR (cardiopulmonary resuscitation) – Aggressive treatments – such as pushing on a patient's chest, inserting a breathing tube or administering electric shocks – to restart breathing and/or a heartbeat.

DNR (Do Not Resuscitate) – A medical order stipulating that CPR will not be used if a patient's heartbeat or breathing stops. A DNR does not mean that other treatments stop or change. A separate order is needed for that. Comfort care and pain medications continue.

Living will – A type of advance directive that lists the kinds of treatments patients do or do not wish to have administered if they cannot make their wishes known. Some areas that may be addressed in this document include the use of artificial nutrition and hydration and breathing machines.

Durable power of attorney for health care – This is not the same as a financial power of attorney. It is an advance directive that designates a person to make medical decisions for you if you are incapable of making them yourself. Sometimes the words "agent" or "proxy" are substituted for power of attorney. Even after naming a durable power of attorney for health care, you still have power to make your own decisions as long as you are able to do so.

Do I know enough about these life-sustaining treatments to make an informed decision?

Every person's situation is unique. Ask your doctor about the specifics of mechanical ventilation (a machine that assists patients who cannot breath on their own), CPR, artificial nutrition and hydration as they relate to your particular situation.

How do I feel about life-sustaining treatments if I am terminally ill, in an irreversible coma or dealing with a chronic illness such as Alzheimer's?

Would you want antibiotics administered to cure an infection that might lead to your death? Would you want food and water administered artificially through a tube? If you were in pain, would you want aggressive pain management, even if it might shorten your life?

What am I most afraid of happening?

You may be most concerned about pain, loss of independence, being kept on life-support machines or being a burden to your family.

If I had a terminal illness, how would I want to spend my last days?

Would you want to go to the hospital for aggressive treatments, or is it more important to stay in your home? What measures could help you spend the rest of your life the way you most want?

What do I see as an acceptable quality of life?

If you are confined to a bed or a machine breathes for you, would you consider that "living"?

Who should I choose as my durable power of attorney for health care?

This very important person should be someone whose values are similar to your own and whom you trust to know and carry out your wishes. That person must be at least 18 years old and be willing to accept the responsibility of making difficult decisions even though others may disagree with them. Make sure this person understands your wishes clearly and has the opportunity to ask questions. Other family members and loved ones should also be told of your wishes.

How can I ensure my organs or body are donated after I die? Is having it noted on my driver's license enough?

Even with the notification on your driver's license, it is best to state your specific wishes on your advance directive and discuss them with your durable power of attorney for health care and family members. Advance approval is needed to donate your body to a medical school. Your doctor should be able to assist you with this request.

How do I go about making an advance directive?

Once you have had a chance to talk with your doctor and family and have considered the above questions, you are ready to put your wishes in writing. You can use many forms to create this document. Versions are available on the Internet, from Chesapeake Regional Medical Center or from your attorney. You do not, however, need an attorney's assistance to complete an advance directive.Please submit a scanned or digital photo of the current DBP account holder's government-issued photo identification. If the person requesting this change is not the DBP account holder, please submit identification for both the account holder and the requestor. Acceptable forms of government-issued identification include:

• State issued driver's license
• State issued photo identification card
• Passport
• Military photo identification

In order for DBP to accept your identification, the person pictured must be clearly identifiable, and the submitted identification must clearly show a complete name, signature, and expiration date. All photo identification and company documents that you provide, as well as this online form, will be stored on secure servers. If a company is listed as the DBP account holder, you must submit one of the following government-issued documents for company identification:

• A copy of the company's business license
• Tax certificate (number alone is not acceptable)
• "Doing Business As" documentation
• Fictitious Name documentation
• IRS 501(c)3 "Determination Letter"
• State issued certificate of tax exemption showing charitable status

For more information, read our blog: Why Every Adult Needs an Advance Directive.