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Advance Directives

An advance directive is a mechanism by which an individual can communicate his or her wishes should they become unable to participate in informed decision making regarding their health care.

An advance directive can have two sections. In one, commonly referred to as the living will, a patient can direct that certain procedures be provided, withheld or withdrawn if the patient is terminally ill and unable to communicate directions regarding life-prolonging procedures.

The other section, commonly referred to as the durable power of attorney for healthcare, a patient can identify a person to make treatment decisions for the patient if the patient is incapable of making treatment decisions.

Patients may make either type of decision in the advance directive, or they may make both decisions. A physician's order (or orders) in a patient's medical record is required to implement the wishes expressed by the patient in the advance directive.

Only a physician may accept a patient's oral advance directive. An oral advance directive is valid only if a patient declares treatment wishes after the patient has been diagnosed with a terminal condition and only if the directive is made in the presence of the attending physician and two witnesses. In such a case, the physician should document the patient's oral advance directive in the patient's medical record.

To implement the living will portion of an advance directive, a physician must diagnose a patient who is incapable of making an informed treatment decision as terminally ill. The Virginia statute does not require this diagnosis to be confirmed by a second physician. The advance directive will direct that certain life-prolonging procedures be provided, withheld or withdrawn from the patient. The statute includes artificial nutrition and hydration in the definition of life-prolonging procedures.

VIRGINIA'S NATURAL DEATH ACT

Virginia's Natural Death Act was enacted in 1983 (Virginia Code 54.32.8:1) to permit Virginians to record their wishes regarding extraordinary care in the event of terminal illness. A declaration is the legal instrument developed by the state legislature to implement the Act. Fill out this declaration and give it to your physician and any relatives and friends you would like to have a copy. You must sign in the presence of two witnesses, and both witnesses must sign in your presence. Blood relatives or spouse may not be witnesses.