What is a living will?

A living will is a legal document that tells your physician how you want to be treated if you are terminally ill or permanently unconscious and cannot make decisions for yourself. A living will says that life-prolonging medical interventions that would serve only to prolong your dying should not be used. A living will only applies if you are terminally ill or permanently unconscious AND too sick to make decisions for yourself.

 

What is a medical power of attorney?

A medical power of attorney is a legal document, a type of advance directive, that allows you to name a person to make healthcare decisions for you if you are unable to make them for yourself.

 

How is the medical power of attorney different from the living will?

A living will is only in effect if you are terminally ill or permanently unconscious AND too sick to make decisions for yourself. A living will tells your physician what treatment you do and do not want. You can write in other specific instructions. A living will is a written record of decisions that you have made yourself.

On the other hand, the medical power of attorney allows you to choose someone else to make healthcare decisions for you if you are too sick to make them for yourself. This person is called your medical power of attorney representative. Your representative can make any healthcare decision that you could make if you were able. A medical power of attorney allows you to give specific instructions to your representa­tive and our physician about the type of care you would want to receive.

The medical power of attorney allows your representative to respond to medical situations that you might not have anticipated and to make decisions for you with knowledge of your values and wishes.

 

I am a young person in good health. Do I really need to create a formal advance directive?

Advance directives are for all adults, including mature minors and emancipated minors. We never know when an accident or serious illness will leave us incapable of making our own healthcare decisions.

 

What if I already have a living will? Do I need to create a medical power of attorney?

Most West Virginians complete both a medical power of attorney and a living will. Since the medical power of attorney is a more flexible document and allows you to name someone to make decisions for you, it is advisable to create a medical power of attorney even if you have already signed a living will or decide not to do a living will.

The person you appoint as your medical power of attorney representative can help see that the preferences expressed in your living will are carried out. Some people, however, do not have someone whom they trust or who knows their values and preferences. These people should consider creating a living will so that they can leave specific directions about their end-of-life treatment.

If you choose to sign both documents, you should store them in the same place to help assure that your representative will know to respect all of your wishes. You may also complete a com­bined living will and medical power of attorney document which combines both documents into one form. The Center for End-of-Life Care strongly encourages you to submit your advance directive to the e-Directive Registry so that your wishes will be known and respected.

 

Should I complete a new living will or medical power of attorney if I completed one before June 11, 2000?

On June 11, 2000, a new West Virginia law went into effect that made several changes to the living will and medical power of attorney forms. Most importantly, the new law requires only one physician to decide whether you are able to make your own healthcare decisions. Forms completed prior to the new law required two physicians to make this determination. The new forms also are written in clearer, easy-to-understand language. If you want to take advantage of these changes, you should complete a new living will and medical power of attorney.

 

Can I combine my living will and medical power of attorney in one form?

Yes. If you do not want CPR, feeding tubes, breathing machines, or other life-prolonging interventions if you become terminally ill or permanently unconscious, then you can use one document that combines both the living will and the medical power of attorney forms.

 

Can I still make my own healthcare decisions once I have created an advance directive?

Yes. Your advance directive does not go into effect until you are no longer able to state your own wishes. As long as you can do this, you make your own decisions.

 

If I decide to create a medical power of attorney, how should I choose my repre­sentative?

Choose someone who knows your values and wishes, and whom you trust to make decisions for you. Do the same for a successor representative. Ask both to be sure they understand and agree to be your representative.

You may, but do not have to, choose a family member to be your representative. Regardless of your choice, your representative should be someone who will be available if needed and who will make decisions the way you would decide. 

Name only one person each as your representative and your successor representative. Do not choose your physician, or another person who is likely to be your future healthcare provider, as your representative or successor representative.

 

What instructions should I give my representatives concerning my health care?

You may give very general instructions and preferences, or be quite specific. It would be helpful to your representatives to have directions from you about medical conditions in which you would NOT want life-prolonging intervention, particularly medically administered food and water (tube feedings), cardiopulmo­nary resuscitation (CPR), and the use of machines to help you breathe. You should also tell your representative if you want to be an organ and tissue donor.

Some people choose to write their representatives a letter stating their personal values and wishes, their feelings about life and death, and any specific instructions, and to attach a copy of this letter to their medical power of attorney.

Talk with your representatives about your choices and personal values and beliefs. Make sure they know what is important to you. This information will help them make the decisions that you would make if you were able.

 

Can any person create an advance directive?

Yes. Any adult (including a mature or emancipated minor) who has the capacity to make decisions for him or herself can create an advance directive.

 

Do I need a lawyer to create an advance directive?

No. Both the medical power of attorney and living will can be created without the assistance of a lawyer. Both can be downloaded for free from our Forms & Resources page, or obtained by calling the Center at 877-209-8086.

 

Who should witness my signature on my advance directive?

Your witnesses must be at least 18 years of age and not related to you by blood or marriage. Choose persons who will not inherit any of your property. Do not choose the person you named as your representative or your successor representative or your physician as your witness.

 

How can I find a Notary Public to complete my medical power of attorney form?

Businesses such as banks, insurance agents, government offices, hospitals, physicians’ offices, and automobile associations have or can direct you to a notary public.

 

What should I do with my advance directive after I sign it?

After your advance directive is signed, witnessed and notarized, give one copy each to your representative, your successor representative, your physician, and your local hospital. Keep the original document in a safe location where it can be easily found. Your safe deposit box is most likely NOT the best place for your advance directive unless you are certain someone close to you has access to the safe deposit box if you become incapacitated.

Make sure your representative knows where the original is so it can be shown to your physician on request. A photo copy of your advance directive is legally valid.

The West Virginia Center for End-of-Life Care (WVCEOLC) through the WV Health Information Network (WVHIN) has established the WV e-Directive Registry. With the permission of patients, this electronic registry houses and makes available to treating healthcare providers West Virginians’ advance directive forms, do not resuscitate cards, and Physician Orders for Scope of Treatment (POST) forms. This is a password-protected – HIPAA compliant Registry that will make accurate, relevant information about patients’ advance directives and medical orders available in a medical crisis. It is accessible 24/7 to healthcare providers and ensures that patients’ wishes will be respected throughout the continuum of healthcare settings.

The advance directive forms on the WV Center for End-of-Life Care web page contain an Opt-In box. If you would like to have your advance directive forms included in the Registry, you must INITIAL the box giving your permission to do so and FAX the forms to the Registry at 844-616-1415. If your advance directive form is older and does not contain the Opt-In box at the top, you can download the WV e-Directive Registry Sign-Up form.

You may submit your advance directive forms, do not resuscitate card, or Physician Orders for Scope of Treatment (POST) form to the WV e-Directive Registry by FAXing the forms or document to 844-616-1415. If you do not have a FAX machine available, you may mail a copy of your forms to the WV e-Directive Registry, 1195 Health Sciences North, Morgantown, WV 26506.

  

What if my physician or my family does not agree with my treatment choices or healthcare decisions?

You can prevent this from happening by talking with your family and healthcare providers about your decisions and personal values and beliefs. If others understand your choices and the reasons for them, there is less of a chance that they will challenge them later.

If you have made your wishes known in an advance directive and a disagreement does occur, by law, your physician and your representative must respect your wishes. You have a right to refuse or consent to health care. If your physician refuses to respect your wishes, he or she must transfer your care to another physician.

The consent or refusal of your medical power of attorney representative is as meaningful and valid as your own. The wishes of other family members will not override your own clearly expressed choices or those made by your representative on your behalf.

 

Do I have to sign an advance directive to receive healthcare treatment?

No. A physician or other healthcare provider cannot require you to complete an advance directive as a condition for you to receive services.

 

Will another state honor my advance directive? 

Laws differ somewhat from state to state, but in general, a patient’s expressed wishes will be honored. No law or court has invalidated the concept of advance directives, and an increasing number of statutes and court decisions support it. Many if not most states will honor your advance directives.

 

What if I change my mind about who I want to be my representative or about the kind of treatment I want?

You should review your advance directive periodically to make sure it still reflects your wishes. The best way to change your advance directive is to create a new one. The new advance directive will automatically cancel the old one. Be sure to notify all people who have copies of your advance directive that you completed a new one. Collect and destroy all copies of the old version. 

Remember to submit your new advance directive to the WV e-Directive Registry by faxing it to 844-616-1415 or mailing a copy to the WV e-Directive Registry, 1195 Health Sciences North, Morgantown, WV 26506.

 

How can I be sure that the wishes expressed in my advance directive will be followed?

Be sure your physician and hospital have a current copy. Bring a copy with you if you are admitted to a healthcare facility. Tell people where you keep your advance directive. FAX a copy of your advance directive to the WV e-Directive Registry at 844-616-1415, so that your wishes will be known in a medical emergency.

 

If my heart should stop, I want to be resuscitated in my current condition. Can I request CPR on my living will?

No, CPR is not consistent with the purpose of a living will. A living will is for patients who want to avoid life-sustaining interventions such as CPR when they are dying or permanently unconscious and unable to speak for themselves. Under state law, a request for CPR in the Special Directives or Limitations of a living will is invalid because it is contradictory to the purpose of the living will.

 

Can I write my wishes for funeral arrangements on my advance directive?

Yes, you can give the person you name as your medical power of attorney representative the authority to make decisions for you about funeral arrangements or cremation. The way to do so is to write instructions in the Special Directives or Limitations on this section of the medical power of attorney form or the combined medical power of attorney-living will form. To grant authority to your medical power of attorney representative, include a sentence as follows: “I authorize my representative to make decisions regarding my funeral arrangements or cremation.”