Patient Self-Determination Act
Summary of Policy Statement
In accordance with North Carolina law, Catawba Valley Medical Center is
providing information concerning the Patient Self Determination Act of
1990 and the Advance Instruction for Mental Health Treatment Act of 1997
to all patients admitted to the medical center.
Catawba Valley Medical Center supports the competent adult’s right
to make decisions regarding the acceptance or refusal of medical, surgical
or mental health treatment in accordance with North Carolina laws.
All patients will be asked if they have advance directives. The patient’s
response will be documented in his or her medical record. Information
will be provided for each inpatient at Catawba Valley Medical Center.
In order to implement a patient’s advance directive, Catawba Valley
Medical Center has made the following provisions:
- When a copy of the patient’s advance directive is provided, the admitting
nurse will place it in the patient’s chart.
- If a copy of the patient’s advance directive is not available, the
admitting nurse will complete an Advance Directive Summary and place it
in the patient’s chart.
- The attending physician will be notified of the existence of the advance
directive immediately upon admission.
- The advance directive will be prominently placed in the patient’s
chart along with an advance directive sticker, which will inform all medical
personnel and medical center staff about the existence of the document.
MEDICAL CARE DECISIONS AND ADVANCE DIRECTIVES
WHAT YOU SHOULD KNOW
Who decides about my medical care or treatment?
If you are 18 or older and mentally competent, you have the right to make
decisions about your medical treatment. You should talk to your doctor
or other health care provider about any treatment or procedures 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. If you want to control
decisions about your health care, even if you become unable to make or
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 health care
you want if you lose the ability to make the decisions for yourself. There
are three ways for you to make your directions known:
- Living Will
- Health Care Power of Attorney.
- Advance Instruction for Mental Health Treatment
Do I have to have an advance directive, and what happens if I don’t?
Making a living will, appointing a health care power of attorney or making
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
or a person named to make medical care decisions for you (health care
agent), your doctor or health 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 what care
you want to receive if you are (1) terminally and incurably sick or (2)
in a vegetative state in which you will not recover. In a living will,
you can direct your doctor not to use heroic treatment 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).
What is a health care power of attorney or health care agent?
In North Carolina, you can name a person to make medical care decisions
for you if you later become unable to decide for 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
you would want and what you would not want. Your agent then knows what
choices you would make. Your health care agent may also be designated
in a Durable Power of Attorney document.
How would I choose a health care agent?
You should choose someone you trust. Discuss your wishes with that person
before you sign the power of attorney form. The person chosen must be
mentally competent and at least 18 years of age.
What is an advance instruction for mental health treatment and an attorney-in-fact?
Advance instruction for mental health treatment means a written instrument,
signed by two qualified witnesses, that makes a declaration of instructions
that also provides information and preferences regarding mental health
treatment, appoints an attorney-in-fact and continues in effect for a
period of two years. An attorney-in-fact means an adult appointed to make
mental health treatment decisions for a person under an advance instruction
for mental health treatment. An advance instruction for mental health
treatment may be combined with a health care power of attorney.
How do I make an advance directive?
You must follow several rules when you make a formal living will, appoint
a health care power of attorney, or make 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. Your directives must be written and signed by you while you
are able to understand your condition and treatment choices and to make
those choices known. All types of advance directives must be witnessed
by two qualified people and be notarized. Medical center staff members
cannot be used as witnesses. We will provide a notary should you wish
to make an advance directive while a patient here.
Are there forms I can use to make an advance directive?
Yes. 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
When does an advance directive go into effect?
The powers granted by your health care power of attorney go into effect
when your doctor states in writing that you are not able to make known
your health care choices. When you sign a health care power of attorney,
you may name the doctor you would want to make this decision. 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. An advance instruction
for mental health treatment goes into effect when you lack the capacity
to make and communicate mental health treatment decisions for yourself.
What happens if I change my mind?
You can cancel a living will both by destroying all the copies of it and
by informing your doctor that you want to cancel it. You can change your
health care power of attorney or attorney-in-fact by destroying all the
signed copies or signing another one, and by telling your doctor and each
health care agent about the change.
COMMUNICATING YOUR WISHES
Who to talk with 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 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 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 healthcare provider, your
healthcare agent, your hospital of choice and any close friends who might
be asked about your care should you become unable to make decisions.
You may want to register your advance directive free with the U.S. Living
Will Registry by calling 1-800-584-9455. In addition, for a small fee
you may register your advance directive with the North Carolina Secretary
of State’s Office in Raleigh, NC. For more information call 1-919-807-2000.
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 make an advance directive
in North Carolina too. Or, you could have your lawyer review the advance
directive from the other state.
Note: This document has been developed with information provided by the
North Carolina Division of Medical Assistance in cooperation with the
North Carolina Department of Human Resources Advisory Panel on Advance