Advance directives

This information was developed by the North Carolina Division of Medical Assistance in cooperation with the Department of Human Resources Advisory Panel on Advance Directives in 1991. Revised 1999.

If you are 18 or older, married or legally emancipated and have the capacity to make and communicate healthcare decisions, you have the right to make decisions about your medical/mental health treatment. You should talk to your doctor or other healthcare provider about any treatment or procedure so that you understand what will be done and why. You have the right to say yes or no to treatments recommended by your doctor or mental health provider. If you want to control decisions about your medical/mental healthcare even if you become unable to make or to express them yourself, you will need an "advance directive."

An advance directive is a set of directions you give about the medical/mental healthcare you want if you ever lose the ability to make decisions for yourself. North Carolina has three ways for you to make a formal advance directive. One way is called a "living will"; another is called a "healthcare power of attorney"; and another is called an "advance instruction for mental health treatment."

Making a living will, a healthcare power of attorney or an advance instruction for mental health treatment is your choice. If you become unable to make your own decisions, and you have no living will, advance instruction for mental health treatment, or a person named to make medical/mental health decisions for you (healthcare agent), your doctor or medical/mental healthcare provider will consult with someone close to you about your care.

In North Carolina, a living will is a document that tells others that you want to die a natural death if you are terminally and incurably sick or in a persistent vegetative state (coma or irreversible advanced dementia) from which you will not recover. In a living will, you can direct your doctor not to use heroic treatments that would delay your dying, for example by using a breathing machine ("respirator" or "ventilator"), or to stop such treatments if they have been started. You can also direct your doctor not to begin or to stop giving you food and water through a tube ("artificial nutrition or hydration").

In North Carolina, you can name a person to make medical/mental healthcare decisions for you if you later become unable to decide yourself. This person is called your "healthcare agent." In the legal document you name who you want your agent to be. You can say what medical mental health treatments you would want and what you would not want. Your healthcare agent then knows what choices you would make.

You should choose an adult you trust and discuss your wishes with the person before you put them in writing.

In North Carolina, an advance instruction for mental health treatment is a legal document that tells doctors and healthcare providers what mental health treatments you would want and what treatments you would not want if you later become unable to decide yourself. The designation of a person to make your mental healthcare decisions, should you be unable to make them yourself, must be established as part of a valid healthcare power of attorney.

You must follow several rules when you make a formal living will, healthcare power of attorney or an advance instruction for mental health treatment. These rules are to protect you and ensure that your wishes are clear to the doctor or other provider who may be asked to carry them out. A living will, a healthcare power of attorney and an advance instruction for mental health treatment must be written and signed by you while you are still able to understand your condition and treatment choices and to make those choices known. Two qualified people must witness all three types of advance directives. The living will and the healthcare power of attorney also must be notarized. You can also register your form with the Secretary of State if you choose to do so. There is a $10 fee per document.

Yes. There is a living will form, a healthcare power of attorney form and an advance instruction for mental health treatment form that you can use. These forms meet all of the rules for a formal advance directive. Using the special form is the best way to make sure that your wishes are carried out. The forms are available at the hospital, by clicking on the links above, and from NC Secretary of State's website.

A living will goes into effect when you are going to die soon and cannot be cured, or when you are in a persistent vegetative state (coma or irreversible advanced dementia). The powers granted by your healthcare power of attorney go into effect when your doctor states in writing that you are not able to make or to make known your healthcare choices. When you make a healthcare power of attorney, you can name the doctor or mental health provider you would want to make this decision. An advance instruction for mental health treatment goes into effect when it is given to your doctor or mental health provider. The doctor will follow the instructions you have put in the document, except in certain situations, after the doctor determines that you are not able to make and to make known your choices about mental health treatment. After a doctor determines this, your healthcare power of attorney may make treatment decisions for you.

You can cancel your living will anytime by informing your doctor that you want to cancel it and destroying all the copies of it. You can change your healthcare power of attorney while you are able to make and make known your decisions by signing another one and telling your doctor and each healthcare agent you named of the change. You can cancel your advance instruction for mental health treatment while you are able to make and make known your decisions, by telling your doctor or other provider that you want to cancel it. If you registered your form(s) with the Secretary of State, you can also file a request to have them removed from the registration.

You should talk to those closest to you about an advance directive and your feelings about the healthcare you would like to receive. Your doctor or healthcare provider can answer medical questions. A lawyer can answer questions about the law. Some people also discuss the decision with clergy or other trusted advisers.

Keep a copy in a safe place where your family members can get it. Give copies to your family, your doctor or other medical/mental healthcare provider, your healthcare agent and any close friends who might be asked about your care should you become unable to make decisions.

An advance directive from another state may not meet all of North Carolina's rules. To be sure about this, you may want to make an advance directive in North Carolina too. Or you could have your lawyer review the advance directive from the other state.

You can talk to your provider, stop by Administration at Iredell Memorial Hospital during business hours, or read the frequently asked questions at the Secretary of State's website.

Other forms that you may want to be aware of include authorization to consent to healthcare for a minor, organ donor card, portable do not resuscitate (DNR) orders, and medical orders for scope of treatment (MOST). An authorization to consent to healthcare for a minor is a legal document that allows parents with sole or joint legal custody of a minor (under 18) to authorize another adult to make certain healthcare decisions for their child or children in their absence.

An organ donor card is a document that allows you to donate your organs. You can become an organ donor by expressing your desire to donate in your will, by authorizing the NC Division of Motor Vehicles to put an organ donor symbol on your driver's license or identification card, by completing an organ donor card or other document, or by authorizing that a statement or symbol be included on the NC Organ Donor Registry. You also may authorize an agent to make an anatomical gift of organs under a healthcare power of attorney. To make sure your wishes are honored, you should discuss organ donation with your family, friends and healthcare providers so they know and can carry out your wishes. You can get an organ donor card from the North Carolina Department of the Secretary of State Advance Healthcare Directive Registry at http://www.secretary.state.nc.us/ahcdr or click on the link above.

A DNR is a medical order that can be followed by emergency medical responders or other healthcare providers that tells them not to attempt cardiopulmonary resuscitation (CPR) if your heart and breathing stop (cardiopulmonary arrest). Because it is portable, it can be followed in different settings (for example, in your home, in a nursing home or in a hospital). Since a portable DNR order is a physician or medical order it must be signed by your physician (in North Carolina, physician assistants and nurse practitioners also may issue these orders). It is effective when it is completed and signed by your physician (or physician assistant or nurse practitioner). It can be canceled by destroying or writing "void" on the original form. Portable DNR orders must be obtained from your physician. For more information, be sure to talk to your physician or other healthcare provider.

Called a MOST form, like a portable DNR order it is a medical order that can be followed in different settings such as in the home, nursing home, hospital, etc. A MOST form contains instructions for CPR and also addresses other end-of-life treatments that you may or may not want to receive. For example, a MOST can tell emergency medical responders and other healthcare providers what level of treatment you would like to receive, such as whether you would like to receive antibiotics or artificial nutrition and hydration through tubes. While a MOST is a medical order that must be signed by your physician (or physician assistant or nurse practitioner), it also must be signed by you or, if you are not able to make or communicate your healthcare decisions, by someone who is legally recognized to speak for you. A MOST can be canceled by destroying the original form or indicating on the form that it is void. A MOST form must be obtained from your physician. For more information, be sure to talk to your physician or other healthcare provider.