Advance Care Planning
What is Advance Care Planning (ACP)?
Advance care planning involves making determinations and having conversations about future health decisions and medical care. It provides direction to health care professionals when you can no longer communicate your wishes, possibly due to an accident or illness.
ACP empowers you to make your own health care decisions, so you can share what you want your medical care to look like and who you would prefer to be your health care agent (to speak on your behalf). Also, ACP helps you explore the types of decisions that need to be made in order to set goals of care ahead of time.
ACP cuts down on conflict among loved ones because it gives them a guideline of preferences, so they know what type of medical care you have chosen for yourself.
Sometimes decisions have to be made about whether or not to keep you alive, so it helps to have these conversations in advance in order to carry out your wishes. Some examples of medical interventions used to keep you alive include cardiopulmonary resuscitation (CPR), ventilators, artificial nutrition and dialysis.
Definition of Advance Directives
Your desires are written up in an Advance Directives document. This document defines the limits of care or names a surrogate decision maker (health care agent) if you lack the capacity to make or communicate decisions about medical care for yourself. Advance Directives allow you, the patient, to express your end-of-life goals of care in the event of a crisis.
Types of Advance Directives
Health Care Power of Attorney
In North Carolina, you can appoint any adult you trust to make medical/mental health care decisions for you if you become unable to decide yourself. This person is called your “health care agent.” In this legal document, you name who you want your health care agent to be and describe the care you want. It is important that you discuss with your health care agent what medical treatment/mental health treatments you would want and what you would not want if you become unable to make or express your wishes yourself. Your health care agent then knows what choices you would make.
Living Will
In North Carolina, a living will is a document that tells others that you want to die a natural death if you have an incurable or irreversible condition that will result in your death within a relatively short period of time, become unconscious and to a high degree of medical uncertainty, will never regain consciousness or suffer advanced dementia or other substantial loss of cognitive ability that is irreversible. With a living will, you can direct your doctor not to use life-prolonging measures such as mechanical ventilation, dialysis, antibiotics, artificial nutrition and hydration, and similar forms of treatment. Life-prolonging measures do not include comfort measures or palliative care. This document can also give guidance to your family or health care agent if you have a health care power of attorney.
Medical Orders for Scope of Treatment (MOST) completed by physician
You will fill out this form to determine the level of life-sustaining treatments you would prefer in order to prolong your life or allow you to pass away. You should request this form be filled out by your physician, so your desires for end-of-life care are honored.
Do Not Resuscitate (DNR) completed by physician
A Portable DNR order is a medical order that can be followed by emergency medical responders and other health care providers. It tells them not to attempt cardiopulmonary resuscitation if your heart and breathing stops (cardiopulmonary arrest). It is portable; therefore, it can be followed in different settings such as your home, a nursing home or a hospital. Because a Portable DNR is a medical order, it must be signed by your physician, physician assistant or nurse practitioner before it can go into effect. It can be cancelled by destroying the document or writing “void” across the form. For more information, speak with your physician.
Five Wishes
Your power of influence over your end-of-life care comes down to five wishes. You may determine the following about your care:
- Wish 1: The person you would like to make decisions for you when you are no longer able to do so
- Wish 2: The type of medical care you would like as well as the type you would not like
- Wish 3: The level of comfort you would like administered to help you decrease and/or tolerate pain
- Wish 4: The way you would like to be treated by others
- Wish 5: What you would like shared with your loved ones about your health care
Notarization
North Carolina Advance Directives must be signed in the presence of a notary and two witnesses.
We do not notarize the following:
- Financial documents (durable power of attorney)
- Estate documents
- Personal Wills
Special Programs
- Day of Remembrance Service
- National Healthcare Decisions Day, April 16
- Partnership with Palliative Care, special projects and programs
Forms
NC Practical Form (Healthcare Power of Attorney)
Medical Care Decisions and Advance Directives Pamphlet
Medical Care Decisions and Advance Directives Pamphlet (Spanish)
Advance Health Care Directive (Spanish)
Contact Us
For any questions, please contact the Spiritual Care Department at 919-350-8556.