MY ADVANCE CARE PLANNING GUIDE

Transcription

1 MY DVNCE CRE PLNNING GUIDE For North Carolina! K L T s Lt s and our valu lthcar. a Tll us y h r u bout yo blifs a n nvrsatio o c h t h av ily. Tak timrpthoysician and your fam with you d honst. n a n p o lways b out your b a t b u o Lav nnoddprfrncs. valus a do dat p u s t n ur docum o y p K abl. and avail W want to know your wishs so w can honor thm. To complt an dvanc Car Plan: Go to Call Sntara lbmarl Mdical Cntr (252) or th Sntara Cntr for Halthcar Ethics at (757) or Sntara ( ) sk your physician or halthcar providr

2 Tabl of Contnts Hav th TLK Protct your rights to control halthcar dcisions...1 Important Convrsations...2 Trms You May Nd to Know...3 What Powrs am I Giving to my Halthcar gnt?...6 ustions and nswrs...7

3 Hav th TLK! Protct Your Right to Control Your Halthcar Dcisions Halthcar is vitally important to vryon. Whrvr you ar, whatvr th situation, you want to b sur you rciv xcllnt mdical tratmnt. But vn mor importantly, you want your mdical choics to b undrstood and honord. Th law guarants your right to mak thos dcision about your mdical car, vn whn you ar too sick or injurd to mak your wishs known. Ths rights giv you control ovr your choics at a critical tim in your lif. You can choos to accpt or rfus any mdical tratmnt that is offrd by your physicians. Your physicians will assist you by informing you of th risks of th mdical intrvntions, th bnfits you might xpct and possibl altrnativs. But, how can you b sur that your choics will b honord if you ar unabl to spak for yourslf? Having Mom s dvanc Car Plan mad things so much asir at a difficult tim. Now I am doing th sam for my own family. If you plan now, in advanc, you can mak sur your wishs ar known, and that you gt th kind of car you want and rliv your family of having to mak difficult and strssful choics. You dcid, in advanc, in writing, what your halthcar choics ar if you cannot spak for yourslf, and you can spcifically dirct th kind of mdical tratmnt you do or do not want if,.g. you bcom trminally ill, or hav a prmannt and svr brain injury with no hop of improvmnt or rcovry. You can lt your family, frinds, doctors, and halthcar providrs know your tratmnt wishs through your dvanc Car Plan. 1

4 Important Convrsations about Your Halthcar Choics 2 s (North Carolina - dvanc Dirctiv for a "Natural Dath" and Halth Car Powr of ttorny) ar availabl from any staff mmbr orthy can also b downloadd at ~

5 Trms You May Nd to Know Th following trms ar rfrrd to in this booklt. W hop this list will hlp you undrstand som of th trms and what thy may man for you as you mak halthcar choics for your futur. dvanc Car Planning: procss of dcision-making don in advanc of an illnss or injury to plan with your family, physicians, or spiritual ladr what choics you would mak if you bcam unabl to communicat thos choics for yourslf. Somtims th TLK is don with a traind dvanc Car Planning Facilitator. dvanc Car Plan: n dvanc Car Plan is a trm that includs dvanc Dirctiv for a Natural Dath as wll as a Halth Car Powr of ttorny. Whil th contnt may b th sam or similar, th main diffrnc is an dvanc Car Plan puts mor mphasis on TLKing with family, physicians and spiritual advisors about your wishs. Cardiopulmonary Rsuscitation (CPR): CPR involvs chst comprssions, mdications, lctric shock, and a brathing tub connctd to a mchanical vntilator. Th risks and bnfits of this tratmnt should b discussd with your physician with any chang in your halth or whn you hav a srious or lif-limiting illnss. Dclarant/Principal dclarant is anothr word for th individual signing th dvanc Dirctiv for a Natural Dath. principal is anothr word for th individual appointing halthcar agnt(s) pursuant to a Halthcar Powr of ttorny. Bcaus th dclarant and principal ar th sam prson, oftn ths trms ar usd intrchangably. Facility Do Not Rsuscitat Ordr (DNR): In a hospital or othr halthcar facility, DNR is a physician s ordr to withhold CPR from you in th vnt of cardiac or rspiratory arrst. n dvanc Car Plan dos not automatically bcom a DNR ordr. This must b discussd with, and implmntd by your physician. Portabl Do Not Rsuscitat Ordr (DNR): writtn physician s ordr to withhold CPR in th vnt of cardiac or rspiratory arrst that can travl with th patint. This documnt must b on th Stat approvd DNR form, or MOST form (Mdical Ordr for Scop of Tratmnt), to b honord by Emrgncy Mdical Srvics. Halthcar gnt: n adult appointd by you to mak halthcar dcisions for you. This prson spaks for you only whn you can no longr spak for yourslf. If you hav mad your wishs known through a dvanc Car Plan or hav prsonally discussd your wishs with your halthcar agnt, h or sh is bound by law to mak dcisions in accordanc with your wishs. If thy do not know your wishs, thy will mak dcisions thy bliv ar in your bst intrst and that you would hav mad for yourslf. This agnt may also b idntifid as a Mdical Powr of ttorny or Halthcar Proxy dpnding on th sourc of th documnt. 3

6 4 Lif-Prolonging Procdur: ny mdical procdur, tratmnt or intrvntion which: (i) uss mchanical or othr artificial mans to support and prolong your lif if you hav no rasonabl xpctation of rcovry from a trminal condition; and (ii) whn applid to you in a trminal condition, would srv only to prolong th dying procss. Th trm includs artificially administrd hydration and nutrition. Lif-prolonging procdurs do not includ giving you mdication or prforming any mdical procdur ncssary to provid you with comfort car or to allviat your pain. Living Will: Oftn thought of as mdical instructions only for nd of lif, a Living Will can actually captur halth car prfrncs or your blifs and valus for any halthcar crisis. This 'plan' is now incorporatd in dvanc Car Plans and is part of th largr procss. Th trms Living Will, dvanc Dirctiv and dvanc Car Plan ar oftn usd in th sam way. Organ and Tissu Donation: Donation of your organs (such as hart, lungs, livr or kidnys) or othr parts of th body (such as ys, skin and bon) aftr dath. Prsistnt Vgtativ Stat: n incurabl and irrvrsibl condition, causd by injury, disas or illnss, that causs a loss of consciousnss with no bhavioral vidnc of slf-awarnss or awarnss of your surroundings and from which, to a rasonabl dgr of mdical probability, thr can b no rcovry. Your ys may opn and your body may mov, but it is without any slf-awarnss or conscious thought. MOST (Mdical Ordr for Scop of Tratmnt): writtn physician s ordr which includs ordrs to provid or to withhold CPR in th vnt of cardiac or rspiratory arrst, but also may includ ordrs for othr tratmnt options. Lik th Portabl DNR, this form travls with th patint. Surrogat Dcision-Makr: Individual(s) dsignatd by law to mak halthcar dcisions on your bhalf, whn you ar unabl to mak dcisions for yourslf, if you hav not namd a Halthcar gnt or Mdical Powr of ttorny. In ordr of priority, pursuant to N.C. Cod thos prsons ar: guardian of th patint's prson, or a gnral guardian with powrs ovr th patint's prson, appointd by a court, providd that, if th patint has a halth car agnt appointd pursuant to a valid halth car powr of attorny, th halth car agnt shall hav th right to xrcis th authority to th xtnt grantd in th halth car powr of attorny. halth car agnt appointd pursuant to a valid halth car powr of attorny ttorny-in-fact appointd by patint. Th patint s lgal spous. Majority of rasonably availabl parnts and adult childrn of th patint. Majority of rasonably availabl adult brothrs/sistrs of th patint. n individual who has an stablishd rlationship with th patint, who is acting in good faith on bhalf of th patint, and who can rliably convy th patint's wishs. Trminal Condition: n advancd, irrvrsibl condition causd by injury or illnss that has no cur and from which doctors xpct th prson to di, vn with maximum mdical tratmnt. Lif-sustaining tratmnts will not improv th prson s condition and will only prolong th dying procss.

7 Witnss/Notary: prson who will vrify your signatur on an dvanc Car Plan. Th North Carolina dvanc Dirctiv for a Natural Dath and Mdical Powr of ttorny must b witnssd by two popl ovr 18 yars of ag, along with a Notary. ll witnsss must comply with th following: s ny witnsss must not b rlatd by blood or marriag to th dclarant. s Should not hav any rasonabl xpctation that thy would b ntitld to any portion of th stat of th dclarant upon th dclarant's dath undr any will or codicil of th dclarant thn xisting, or pursuant to th Intstat Succssion ct. s May not b th attnding physician, a licnsd halth car providr that is a paid mploy of th attnding physician, a paid mploy of a halth facility in which th dclarant is a patint, or an mploy of a nursing hom or any adult car hom in which th dclarant rsids. s May not hav a claim against th dclarant or th stat of th dclarant at th tim of th dclaration. s Th documnt must b provd bfor a clrk of court or a notary public. 5

8 What Powrs am I Giving to my Halthcar gnt? Onc it has bn dtrmind by your attnding physician that you no longr ar abl to spak for yourslf, your Halthcar gnt has th powr to (or as authorizd/limitd in your dvanc Car Planning documnts: Rqust, rciv, and rviw any information, rgarding physical or mntal halth, including, but not limitd to, mdical and hospital rcords, and to consnt to th disclosur of this information. Employ and discharg halthcar providrs; Consnt to and authoriz admission to and discharg from a hospital, nursing or convalscnt hom, hospic, long-trm car facility, or othr halth car facility. Giving consnt for, withdrawing consnt for, or withholding consnt for, X-ray, ansthsia, mdication, surgry, and all othr diagnostic and tratmnt procdurs ordrd by or undr th authorization of a licnsd physician, dntist, podiatrist, or othr halth car providr. This authorization spcifically includs th powr to consnt to masurs for rlif of pain. uthorizing th withholding or withdrawal of lif-prolonging masurs. Consnt to and authoriz admission to and rtntion in a facility for th car or tratmnt of mntal illnss. Consnt to and authoriz th administration of mdications for mntal halth tratmnt and lctroconvulsiv tratmnt (ECT) commonly rfrrd to as "shock tratmnt." Othr provisions or limitations may apply. For a complt listing, plas s North Carolina Cod Sction t. sq. 6

9 ustions nswrs and about Your Halthcar Rights If I writ an dvanc Car Plan, will I still rciv mdical tratmnt? Ys. Your dvanc Car Plan includs th kind of mdical tratmnts you DO or DO NOT want. Evn if you choos not to rciv lif-prolonging tratmnt whn you hav a trminal condition, many mdical tratmnts can still b providd to manag your symptoms, rliv pain, and provid support to you and your family. What if I chang my mind? You can rvok or modify your dvanc Car Planning documnts at any tim. This is your plan and it should chang as your halth changs. Can I gt my physician to witnss my signatur on my dvanc Car Planning documnts? I cratd an dvanc Dirctiv for a Natural Dath svral yars ago. Is it still in ffct? Ys. dvanc Dirctivs ar valid until thy ar rvokd. Kp rading to find out how you mak changs or rvok your documnt. Howvr it is important to rviw your documnt at last onc a yar or anytim you xprinc a chang in your halthcar. NO. North Carolina law dos not allow your physician to b a witnss on your dvanc Car Planning documnts. Plas s th Witnss/Notary sction on pag 5 for a mor dtaild list of who may act as a witnss. Do I hav to us th form that is providd by North Carolina? No. Thr ar a varity of forms that ar availabl, and attornys oftn includ an dvanc Dirctiv for a Natural Dath and/or a Halthcar Powr of ttorny in othr stat planning documnts. Providd that ths documnts ar consistnt with th rlvant North Carolina Cod provisions, thr is no particular form that is rquird. 7

10 8 What happns if I cannot mak my own halthcar dcisions? First, your physician must dtrmin that you lack capacity to mak or communicat your halthcar wishs. If this happns, your halthcar providrs will work with th Halthcar gnt namd in your Halthcar Powr of ttorny, or a surrogat mdical dcision makr (s th dfinitions sction), to dtrmin th bst tratmnt that is consistnt with your prviously xprssd wishs. This is why it is important to TLK with your doctors and th popl closst to you about your valus and your wishs. This will rliv popl who car about you of som of th strss thy will xprinc if you bcom vry ill and unabl to communicat. Whom should I choos as my Halthcar gnt? This is an important choic sinc h or sh will hav th authority to dirct your halthcar if you bcom too sick or injurd to mak an informd dcision. You should TLK to th prson you wish to b your Halthcar gnt to xplain your intntions, discuss thir undrstanding of your wishs, and confirm thir willingnss to act on your bhalf. Choos somon who undrstands your valus and choics, and who is willing to honor thm. How can I b sur that my wishs will b followd? Your Halthcar gnt or surrogat mdical dcision makr is rquird by law to follow your statd wishs. If your wishs ar not clar, that prson must us his/hr knowldg of your wishs and valus to mak th dcisions that you would hav mad for yourslf. What about mrgncy situations? dvanc Car Plans ar not dsignd for mrgncy situations, so Emrgncy Mdical Srvic (EMS) prsonnl can not follow an dvanc Car Plan. Howvr, if you wish not to rciv CPR, you may gt a doctor to sign a Do Not Rsuscitat ordr or a MOST form. EMS prsonnl will follow ths ordrs. Can a doctor ovrrid my dvanc Car Plan? Your physician is thically obligatd to follow your wishs as st forth in your dvanc Car Planning documnts; howvr, if h or sh disagrs with your wishs, a physician can transfr car to anothr physician as long as continuity of mdical car is assurd. Will my dsir not to rciv CPR b honord? You may rflct on your dvanc Car Planning documnts that you do not wish to hav Cardiopulmonary Rsuscitation (CPR), but that wish must b mad into a mdical ordr by a physician. If you ar at risk for cardiac or rspiratory arrst, your physician should TLK with you about th risks and bnfits of CPR so that you may agr on what to do if this happns. You and your Halthcar gnt should ask about this if it is not brought up by your doctor. If you wish to hav a Do Not Rsuscitat ordr outsid of a hospital, you will nd a Portabl Do Not Rsuscitat ordr. What kinds of mdical car ar includd in my dvanc Car Planning documnts? You may dirct both gnral halthcar choics, and nd-of-lif car choics. Gnral halthcar may includ such car as dialysis, chmothrapy, blood transfusions, cardiopulmonary rsuscitation (CPR), or any othr tratmnt that you do or do not want if you ar unabl to spak for yourslf. Your nd-oflif instructions may includ th abov as wll as lif prolonging masurs such as mchanical vntilation, artificial nutrition, and artificial hydration or withholding or withdrawing tratmnt.

11 Will my dvanc Car Plan b followd in stats othr than North Carolina? Most stats hav laws allowing individuals to mak dcisions rgarding thir halthcar agnts and mdical tratmnts. Howvr, ths laws may b diffrnt than North Carolina's laws. If you mov to anothr stat, you should dtrmin if your North Carolina form is valid in that stat. Can I chang my mind about my dvanc Car Plan? Ys. You can chang all or any portion of, or rvok your dvanc Car Planning documnts at any tim. Hr s how: Dos my dvanc Car Plan allow m to donat my body to mdical scinc or donat my organs aftr my dath? Ys. Thr ar svral things you should do to mak this an asir procss: TLK to your Halthcar gnt about your wishs. Your Halthcar gnt is obligatd by law to follow your wishs about ths gifts. TLK with your family so that thy undrstand your intntions. Communicat your wish to b an organ donor on your dvanc Car Plan, on your drivr s licns, or on th intrnt at Chang any portion that you dsir on th documnt, initial th chang and hav two witnsss sign along with a notary (following th sam ruls rgarding witnsss outlind on pag 5). Mak sur ths changs can b asily rad. OR Rvok th ntir documnt with a signd, datd writtn statmnt. OR Writ Rvokd across th documnt and sign and dat whr you hav writtn Rvokd. * OR Tar up or dstroy th old dvanc Car Planning documnt(s) and all copis; Thn: - Crat a nw dvanc Car Plan in writing and b sur it is signd, datd and witnssd. Old vrsions should b dstroyd. - Tll your physician that you hav changd your dvanc Car Plan. * W strongly rcommnd as th bst option to writ "Rvokd" and sign/dat dirctly undr. This validats your intnt should copis latr surfac. If you wish to lav your body to mdical scinc, you will nd to mak arrangmnts through on of North Carolina's Mdical Schools or rsarch programs. What should I do whn I hav compltd my dvanc Car Plan? Mak copis and giv thm to your doctors and your Halthcar gnt(s), and kp th original for your own fils. You hav two options to rgistr your dvanc Car Plan: - Th North Carolina dvanc Halth Car Dirctiv Rgistry for a f at - Th US Living Will Rgistry, which is fr of charg through Sntara. Mor information about th US Living Will Rgistry is providd with th Sntara dvanc Car Plan form and at NOTE: ny tim you crat a nw dvanc Car Plan, plas snd a nw copy and a nw Rgistration grmnt to whichvr Rgistry you choos to utiliz. If you nd assistanc with updating or rvoking your dvanc Car Plan, contact Sntara lbmarl Mdical Cntr (252) or th Sntara Cntr for Halthcar Ethics at (757) or Sntara ( ) 9

12 MY DVNCE CRE PLNNING GUIDE If you hav any qustions about your dvanc Car Plan, or if you wish to st an appointmnt with on of our Crtifid dvanc Car Planning Facilitators, plas contact: Sntara Cntr for Halthcar Ethics Call (757) or Sntara ( ) dditional copis of this booklt may b downloadd on your computr by visiting: This booklt is not intndd as lgal advic and you may wish to spak with an attorny bfor signing your dvanc Car Plan.