Transcript Speak for Yourself! Making Your Future Health Care Decisions

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
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You don’t need to talk just yet.
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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
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Think about what you want for the end of your life.
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Consider all the “what ifs” – heart attack, stroke, cancer
•
What matters to me is ______?
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Do I want to live as long as possible no matter the cost?
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Quality of life is more important than quantity of life.
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I wouldn’t mind going to a nursing home.
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Living independently is huge.
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I don’t want my loved ones to know everything about my health.
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Talk with your physician
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Read “Hard Choices for Loving People”
Step 3: Go
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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