Medical Care Decisions
What are my rights? Who decides about my medical care or treatment?
If you are 18 or older and have the capacity to make and communicate health care decisions, you have the right to make decisions about your medical/mental health treatment. You should talk to you doctor or other health care 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 health/mental health care even if you become unable to make or to express them yourself, you will need an "advance directive."
What is an "advance directive?"
An advance directive is a set of directions you give about the medical/mental health care 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 "health care power of attorney"; and another is called an advance instruction for mental health treatment. NHRMC does not condition the provision of healthcare or otherwise discriminate against patients based upon whether they have an advance directive.
Do I have to have an advance directive and what happens if I don't?
Making a living will, a health care 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 ("health care agent"), your doctor or health/mental health care provider will consult with someone close to you about your care.
What is a living will?
In North Carolina, a living will is a document that tells others that you want to die a natural death if you are terminally ill and incurably sick or in a persistent vegetative state 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").
How do I know what to include in a living will document?
A living will document can be downloaded here: Advanced Directives: Living Will, Health Care Power of Attorney forms
Health Care Power of Attorney
What is a health care power of attorney?
In North Carolina, you can name a person to make medical/mental health care decisions for you if you later become unable to decide yourself. This person is called your "health care agent." In the legal document you name who you want your agent to be. You can say what medical treatments/mental health treatments you would want and what you would not want. Your health care agent then knows what choices you would make.
How should I choose a health care agent?
You should choose an adult you trust, discuss your wishes with the person and then put those wishes in writing.
What should be included in a document designating health care power of attorney?
Advanced Directives: Living Will, Health Care Power of Attorney forms
Advance Instruction for Mental Health Treatment
What is an advance instruction for mental health treatment?
In North Carolina, an advance instruction for mental health treatment is a legal document that tells doctors and health care 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 health care decisions, should you be unable to make them yourself, must be established as part of a valid health care power of attorney.
How do I make an advance directive?
You must follow several rules when you make a formal living will, health care 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 health care 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 health care power of attorney also must be notarized.
Are there forms I can use to make an advance directive?
Yes. There are advance directive forms 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.
When does an advance directive go into effect?
A living will goes into effect when you cannot be cured and death is imminent, or when you are in a persistent vegetative state. The powers granted to your health care power of attorney go into effect when your doctor states in writing that you are not able to make or to make known your health care choices. When you make a health care 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 Health Care Power of Attorney may make treatment decisions for you.
What happens if I change my mind?
You can cancel your living will anytime by informing your doctor that you want to cancel it and by destroying all copies. You can change your health care power of attorney while you are able to make and make known your decisions, by signing another one and telling your doctor and each health care 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 you want to cancel it.
Whom should I talk to about an advance directive?
You should talk to those closest to you about an advance directive and your feelings about the health care you would like to receive. Your doctor or health care provider can answer medical questions. A lawyer can answer questions about the law. Some people also discuss the decision with clergy or other trusted advisors.
Where should I keep my advance directive?
Keep a copy in a safe place where your family members can get it. Give copies to your family, your doctor or other health/mental health care provider, your health care agent, and any close friends who might be asked about your care should you become unable to make decisions.
What if I have an advance directive from another state?
An advance directive from another state may not meet all of North Carolina's rules. To be sure about this, you may want to also make an advance directive in North Carolina. Or, have your lawyer review the advance directive from the other state.
Where can I get more information?
If you would be interested in more information or assistance in initiating an advance directive, we can assist you. Please ask your nurse to contact the social worker.
When Difficult Decisions Need to be Made
Medical illness can create stressful situations for everyone involved. For patients, families, friends, doctors, nurses and staff, there may be times when difficult decisions need to be made and the task seems overwhelming. Sometimes life and death decisions or decisions regarding treatment may be painful and complicated. Sometimes there is no obvious answer. Talking about these difficult decisions often helps. New Hanover Regional Medical Center has an Ethics Committee to help you with these situations.
What is an Ethics Committee?
The Ethics Committee is a group of people who are available to listen to your situation objectively and talk to you as you deal with the situation. The committee can help you gather the facts you need to make a decision. Its members will offer suggestions, though no one will be bound by these suggestions. The Ethics Committee exists to help everyone involved to work together to make the best decision possible.
Who is on the Committee?
The committee is made up of physicians, nurses, other health care professionals, clergy, community members and a medical ethicist. All members have been educated in medical ethics.
How do I get in touch with the Ethics Committee?
Issues may be brought to the committee by a patient, family member, physician, nurse or any other hospital staff member. All conversations are held in the strictest confidence. To get in touch with the committee, ask your nurse or call VitaLine at 815-5188 for the physician on call.