Speak for Yourself!
Making Your Future
Health Care Decisions
The future depends on what we
do in the present.
–Mahatma Gandhi
The Facts
29% of West Virginians have been involved
in making medical decisions for a family or
friend in their last days
48% have both a Living Will and a Medical
Power of Attorney
72% would choose to live a shorter time to
avoid pain and suffering
More Facts
55% of West Virginians agree it is important to
talk with their family and doctor about how they
want to be treated at the end of their life
 72% have talked with a family member or close friend
 26% have talked with their doctor
67% prefer to die at home HOWEVER
57% die in a hospital or nursing facility
Why have “the conversation?”
• The time may come when certain treatments offer
little or no benefit or may actually be harmful.
• Enables you to decide on the kind of care you want
at the end of your life
• Assures you that your wishes will be carried out if
you are unable to make decisions for yourself
• A true gift to your loved ones—relieves your family
of the difficult burden of trying to decide what you
might want
Steps to having a conversation
 Step 1: Get Ready!
 Step 2: Get Set!
 Step 3: Go!
 Step 4: Keep going!
Step 1: Get Ready
•
You don’t need to talk just yet.
•
Take your time. Think about it. Start by writing a letter to
yourself or a loved one. Think about having a practice
conversation with a friend.
Step 2: Get Set
•
Think about what you want for the end of your life.
•
Consider all the “what ifs” – heart attack, stroke, cancer
•
What matters to me is ______?
•
Do I want to live as long as possible no matter the cost?
•
Quality of life is more important than quantity of life.
•
I wouldn’t mind going to a nursing home.
•
Living independently is huge.
•
I don’t want my loved ones to know everything about my health.
•
Talk with your physician
•
Read “Hard Choices for Loving People”
Step 3: Go
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Who do you want to include in the conversation?
When would be a good time to talk?
Where would you feel comfortable talking?
What do you want to be sure to say?
 Remember –
 You don’t have to cover everything in the first conversation. This is a process.
 You can change your mind.
 A “good death” means different things to different people and your loved ones may
disagree with your choices. That’s OK. They are your choices.
GO FOR IT!
Step 4: Keep Going
•
Now is the time to put your conversation in writing with
an advance directive
Types of Advance Directives
In West Virginia there are several types
of Advance Directives:
Living Will
Medical Power of Attorney
DNR (Do Not Resuscitate)
POST (Physician Orders for Scope of Treatment)
Traditional Advance Directives
Living Will or Medical Power of Attorney
For future healthcare decisions (What you
would want if . . . )
Cannot address all the possible circumstances
Actionable Advance Directives
DNR and POST
Put into effect immediately
Decisions based on current health status and
present options for care
Clearly defined (black and white)
Living Will
A statement of your wishes if you are terminally
ill or permanently unconscious and heroic
measures are being considered or have been
started
Only applies to the above-mentioned
circumstances
Is a plan for the future
Medical Power of Attorney
Enables you to name a person to make health
care decisions for you if you are unable to make
them for yourself
Applicable in any health care situation where
you are incapacitated
When you recover, you resume responsibility of
your own care
Is a plan for the future
Do Not Resuscitate (DNR)
Doctor’s order
Takes effect immediately
Protects a person’s right to not have CPR
For people for whom CPR would not be helpful
(chronically or terminally ill, frail, advanced age)
The POST Form
 Used for:
 Seriously ill patients (chronic, progressive disease)
 Terminally ill patients
 The frail elderly
 Doctor’s order
 Takes effect immediately
 Goes with the patient where ever he or she goes – home,
hospital, nursing home
 Easy to read, easy to find
 Assures a patient’s end-of-life care wishes will be honored
 Can be completed for a patient by the MPOA or Health Care
Surrogate
When There is No Directive:
Health Care Surrogate
When the patient is unable to make a medical
decision and there is no MPOA in place, the
physician may appoint a Health Care Surrogate
The Health Care Surrogate makes all medical
decisions for the patient.
Selection based on a priority order, but
physician discretion is allowed
Guardianship
When there is no LW or MPOA and no
appropriate person to appoint as HCS, a
guardian is appointed by the courts to make
medical decisions.
There is a cost involved.
It may take weeks to work through the
guardianship process.
MPOA / Durable POA
Medical Power of Attorney is only for medical
decisions.
Durable Power of Attorney is only for legal, financial
or business decisions but may have a “health care
decisions” clause.
May have two different people or the same person
as MPOA/POA
COMMONLY ASKED
QUESTIONS ABOUT
ADVANCE DIRECTIVES
Who Should Have
an Advance Directive?
Advance directives are for any one over the
age of 18 including emancipated and
mature minors.
If I already have a Living Will, do
I need a Medical Power of
Attorney?
Most West Virginians have both.
MPOA is more flexible.
Those who do not have someone to act as
MPOA should consider creating a LW.
Can I still make my own
decisions once I have created
an advance directive?
Yes, your advance directive does not
become effective until you are incapable of
clearly expressing your own wishes.
(Incapacity is determined by a physician,
psychologist or advanced practice nurse.)
Do I need a lawyer to create
an advance directive?
No, but both documents must be signed
and witnessed in the presence of a Notary
Public.
Witnesses must be 18 years of age and not
related to you by blood or marriage.
What do I do with my advance
directive?
After it is signed, witnessed and notarized:
 Give a copy to –
Your representative (who should know where
the original copy is)
 Your successor representative
 Your doctor
 Your local hospital
 Keep the original in a safe place that is easily
located – not your safety deposit box!

What if my doctor or loved
ones disagree with my
decisions?
Communication is the key!
 You can prevent confusion by talking with loved
ones about your personal values and beliefs.
 Remember that these decisions are yours, and they
must be carried out by health care providers.
 If a doctor cannot comply, he or she must transfer
your care to another doctor.
Will another state honor my
advance directive?
Laws differ from state to state, but in
general a patient’s expressed wishes will be
honored.
Will my advance directive from
another state be honored in
WV?
 West Virginia will honor other states advance
directives as long as they are validly completed
according to that states laws or WV law.
 But if you are a WV resident you should
complete a WV advance directive.
 If you live in a bordering state and get the
majority of your health care in WV, you can
complete a WV advance directive.
What if I change my mind about
my representative or
treatment?
 Review your advance directive periodically (tax
time.)
 Create a new one if necessary.
 Collect and destroy all old copies.
 Be sure to tell your loved ones about changes.
 The document with the most recent date is the
one that will be followed.
Can I write my wishes for funeral
arrangements on my Advance
Directive?
Yes, but you must include this sentence in
the Special Directives section:
“I authorize my representative to make
decisions regarding my funeral
arrangements or cremation.”
WV e-Directive Registry
 Through a password protected secure system, will make
your advance directive or medical orders available to
treating health care professionals in the case of an
emergency and your documents can’t be located.
 After you have completed the forms FAX them to:
To obtain current advance directive forms call:
877-209-8086
or go to
www.wvendoflife.org