HEALTH CARE DIRECTIVES, ADVANCE MEDICAL DIRECTIVES, LIVING WILLS, AND “FIVE WISHES”
These terms all describe a type of legal document that expresses an individual's wishes regarding life-prolonging treatment in the event the individual is unable to speak for himself. 

Health care professionals encourage individuals to prepare one of these types of advance directive so that a personal, individual decision is best made and written down before a medical emergency. 

Why have a health care directive?
A health care directive gives the individual choice over health care decisions even if he/she cannot communicate wishes because of mental or physical incapacity. It also provides an opportunity to name another trusted person as the agent to make decisions based on a previously-decided directive.

What happens in the absence of a health care directive?
The individual will receive medical treatment. Health care providers will listen to what people close to the individual says about treatment preferences. Putting wishes in writing in advance clarifies preferences for the medical personel treating you, as well as for family members or close friends.  

How can an individual make a health care directive?
There are forms available from each GHBC social worker and on the internet or a lawyer can draw up a directive. Our social workers recommend filling out the State of Virginia's advance directive. Click HERE for the form. A lawyer is not needed, but a social worker can discuss any questions that arise. To be legally enforceable, the directive must meet the following requirements:

• It must be in writing and dated.
• It must state the individual's name.
• It must be signed by the individual or by someone authorized to sign for him/her at a time when the individual can understand and communicate his/her wishes.
• A notary public or witness verifies the signature. The exact requirement varies from state to state.
• The State of Virginia does not recognize advance directives from other states, so it is suggested that an individual change his/her directive upon moving to Virginia.

What can an individual put in a health care directive?
These are some of the choices:

• Appoint an agent to make health care decisions.
• State goals, values, and preferences about health care.
• State types of medical treatment wanted or not wanted.
• State where he/she wants to be treated.
• Give instructions about artificial hydration or nutrition.
• State mental health restrictions.
• Provide for disposition of the body after death, including whole body donation or specific body tissues, such as eyes.
• State preferences for funeral or memorial arrangements, if any.

Are there limits to what can be put in a health care directive?
Yes. Some examples are:

• The agent must be at least 18 years old.
• The agent cannot be the individual's health care provider, unless the health care provider is a family member or reasons are given for naming this person as the agent.

How long does a health care directive last?
The health care directive lasts until it is changed or cancelled. The directive can be cancelled by any of the following actions:

• Write a statement saying it is cancelled.  
• Destroy it.
• Tell at least two people the desire to cancel it.
• Write a new directive that complies with the requirements of your state.
• Make sure that you update your directive when you have changes in your health.
• Ensure that your agents are aware of the directive and discuss it with them.

What if the health care provider refuses to follow my health care directive?
The health care provider is to follow a directive or any instructions from an agent, as long as the instructions follow reasonable medical practice. If the provider cannot follow the directive's instructions, the provider must inform the agent and document the notice in the medical record. The provider must allow the agent to arrange for transfer to another provider who will follow the agent’s directions.

“Five Wishes” is a user-friendly booklet, published by a nonprofit organization called Aging with Dignity. www.agingwithdignity.org 
“Five Wishes” helps guide an individual through decisions about how to be treated medically, personally, emotionally, and spiritually when seriously ill. A completed, signed, and witnessed “Five Wishes” form has the same legal effect as other types of advanced medical directives. The five wishes are:

• Select the person to make health care decisions if you are unable to make them.
• Specify kinds of medical treatment wanted or not wanted.
• Specify desired comfort measures.
• Say how you want people to treat you.
• Say what you want your loved ones to know.

The “Five Wishes” document does not have to be prepared by a lawyer. Download and print a copy of the Five Wishes booklet HERE.

SHARING INTENTIONS AND PREFERENCES ABOUT END-OF-LIFE TREATMENT WITH  FAMILY, FRIENDS, DOCTORS, AND OTHER IMPORTANT PEOPLE IS THE BEST WAY TO ASSURE THE KIND OF CARE HOPED FOR.