Advance Health Care Planning Advance Health Care Planning and Organ and Tissue and Organ and Tissue

Donation: What You Need to Donation: What You Need to KnowKnow

What is an advance medical What is an advance medical directive?directive?

Allows you to retain control over whether Allows you to retain control over whether your life will be prolonged by certain your life will be prolonged by certain medical procedures if you have a medical medical procedures if you have a medical condition that will result in death in a short condition that will result in death in a short period of timeperiod of time

Documents your wishes in advance if you Documents your wishes in advance if you are unable to speak for yourselfare unable to speak for yourself

Two main documents: health care power Two main documents: health care power of attorney and living willof attorney and living will

What is a Health Care Power of What is a Health Care Power of Attorney (HCPOA)?Attorney (HCPOA)?

Legal documentLegal document Grants your health care agent the power Grants your health care agent the power

to make medical decisions for you if you to make medical decisions for you if you are not competent or if you are not able to are not competent or if you are not able to communicate your wishes. communicate your wishes.

Can also give agent ability to make organ Can also give agent ability to make organ and tissue donations following your death.and tissue donations following your death.

Completely Voluntary -No legal Completely Voluntary -No legal requirement to execute a HCPOArequirement to execute a HCPOA

What is a living willWhat is a living will

Written DocumentWritten Document Sets forth your wishes to withhold or Sets forth your wishes to withhold or

withdraw life-prolonging measure in withdraw life-prolonging measure in certain situationscertain situations

Completely Voluntary -No legal Completely Voluntary -No legal requirement to execute a living willrequirement to execute a living will

NC Passes SL 2007-502 NC Passes SL 2007-502

• In response to the Terri Schiavo case, the NC: In response to the Terri Schiavo case, the NC: •Bar Association, Bar Association, •Medical Society, Medical Society, •Hospital Association, Hospital Association, •Health Care Facilities Association andHealth Care Facilities Association and•Carolinas Center for Hospice Carolinas Center for Hospice

• began a work group to draft clarification of NC began a work group to draft clarification of NC living will and health care POA lawliving will and health care POA law

• House Bill 634 was draftedHouse Bill 634 was drafted

Revisions of NC LawsRevisions of NC Laws

New Living Will formNew Living Will form New HCPOA formNew HCPOA form New MOST form- physician orderNew MOST form- physician order Informed consent law- clarification Informed consent law- clarification

of order of who can consent of order of who can consent Effective October 1, 2007Effective October 1, 2007 Old forms remain validOld forms remain valid

Living Wills– When do they apply?Living Wills– When do they apply?

Old triggering standards:Old triggering standards:

Terminal and incurableTerminal and incurable

oror

Persistent Vegetative statePersistent Vegetative state

Living Wills– When do they apply?Living Wills– When do they apply? NewNew Triggering standards: Triggering standards:

An incurable or irreversible condition An incurable or irreversible condition that will result in death within a that will result in death within a relatively short period of time; relatively short period of time; OROR Unconscious and to a high degree Unconscious and to a high degree of medical certainty, will never regain consciousness; of medical certainty, will never regain consciousness;

OROR Suffers from advanced dementia or any other Suffers from advanced dementia or any other

condition resulting in the substantial loss of cognitive condition resulting in the substantial loss of cognitive ability and that loss, to a high degree of medical ability and that loss, to a high degree of medical certainty, is not reversiblecertainty, is not reversible

Living Wills- What do they direct?Living Wills- What do they direct? New Law-New Law- Withdrawal of Withdrawal of “life-prolonging measures”“life-prolonging measures”

Interventions which Interventions which serve only to artificially postpone serve only to artificially postpone the moment of death by sustaining, the moment of death by sustaining, restoring or supplanting a vital restoring or supplanting a vital function, including mechanical function, including mechanical vent., dialysis, antibiotics, vent., dialysis, antibiotics, artificial nutrition & hydration, etc.artificial nutrition & hydration, etc.

(basically unchanged)(basically unchanged)

MOST FormMOST Form Medical Orders for Scope of Treatment (MOST)Medical Orders for Scope of Treatment (MOST) MOST vs. DNRMOST vs. DNR MOST vs. Advance DirectivesMOST vs. Advance Directives Doctor and Patient/Patient Rep signsDoctor and Patient/Patient Rep signs Medical order – instructs other medical providers Medical order – instructs other medical providers

what level of care to provide to patientwhat level of care to provide to patient TRUMPS LIVING WILL & HCPOATRUMPS LIVING WILL & HCPOA

MOST FormMOST Form Medical Orders for Scope of TreatmentMedical Orders for Scope of Treatment Physician order sheet based on:Physician order sheet based on:

Patient’s medical conditionPatient’s medical condition Patient’s wishesPatient’s wishes

Similar to Portable DNR Similar to Portable DNR travels with PTtravels with PTEXCEPT:EXCEPT: Includes greater detailed Includes greater detailed

wishes, including the right wishes, including the right to request CPRto request CPR

MustMust be signed by MD and PT or PT Agent be signed by MD and PT or PT Agent MustMust be updated at least once a year be updated at least once a year

When is MOST Appropriate?When is MOST Appropriate?

Terminal illnessTerminal illness Advanced diseaseAdvanced disease Prognoses is death Prognoses is death

within a yearwithin a year Debilitating chronic Debilitating chronic

progressive illnessprogressive illness

Purpose of MOSTPurpose of MOST Improve implementation of advance Improve implementation of advance

care planning by:care planning by: Communicating patient’s preferences Communicating patient’s preferences

for end of life care treatment across for end of life care treatment across treatment settingstreatment settings

Encouraging discussion of wishes Encouraging discussion of wishes among patient, doctor, among patient, doctor, family, or surrogatefamily, or surrogate

Benefits of MOSTBenefits of MOST

Promotes patient autonomy by Promotes patient autonomy by documenting treatment preferences and documenting treatment preferences and converting them into MD ordersconverting them into MD orders

Clarifies treatment intentions and Clarifies treatment intentions and minimizes confusion regarding minimizes confusion regarding patient’s preferencespatient’s preferences

The Health Care The Health Care Power of AttorneyPower of Attorney

Section 5Section 5 Is more specific in allowing you to express Is more specific in allowing you to express

special provisions and limitationsspecial provisions and limitations Options to limit authority:Options to limit authority:

• regarding hydration and nutritionregarding hydration and nutrition• mental health care decisionsmental health care decisions• Individual limitations important to youIndividual limitations important to you• Autopsy and disposition of remainsAutopsy and disposition of remains

The Health Care The Health Care Power of AttorneyPower of Attorney

Section 6Section 6 You may grant authority to donate organs/bodyYou may grant authority to donate organs/body

The Health Care The Health Care Power of AttorneyPower of Attorney

Section 7- Guardianship ProvisionsSection 7- Guardianship Provisions

- You nominate your health - You nominate your health care agent as guardiancare agent as guardian

- Guardian must follow - Guardian must follow • GS 35A-1201(a)(5):GS 35A-1201(a)(5):

Health Care Agent vs. GuardianHealth Care Agent vs. Guardian

Old Law:Old Law:Guardian trumped HC Agent.Guardian trumped HC Agent.Once guardian appointed, Once guardian appointed, HCPOA ceased to be effective.HCPOA ceased to be effective. New Law:New Law: HCPOA still effective and HCPOA still effective and HC agent still has authority HC agent still has authority

UNLESSUNLESSGuardian petitions Ct and Ct rules in Guardian’s favorGuardian petitions Ct and Ct rules in Guardian’s favor

What authority is given to the agent What authority is given to the agent for organ and tissue donation?for organ and tissue donation?

No authority is given unless you indicate No authority is given unless you indicate you desire you desire

Authority may be given for:Authority may be given for: Any needed organs or partsAny needed organs or parts Only certain organs or partsOnly certain organs or parts Body for anatomical studyBody for anatomical study

You may also insert special limitations You may also insert special limitations regarding such donations.regarding such donations.

Why is this important?Why is this important?

Right Now: Nearly 3000 people waiting for Right Now: Nearly 3000 people waiting for an organ transplant in North Carolinaan organ transplant in North Carolina

Thousands of people die each year in the Thousands of people die each year in the United States awaiting a suitable donor United States awaiting a suitable donor organorgan

Organ Donation MythsOrgan Donation Myths ““I’m too old to be an organ donor.”I’m too old to be an organ donor.”

““They wouldn’t want my organs – I have too They wouldn’t want my organs – I have too many medical problems.”many medical problems.”

““They only take hearts, kidneys and livers – and They only take hearts, kidneys and livers – and mine aren’t good!”mine aren’t good!”

““It the doctors or the hospital knew I was an It the doctors or the hospital knew I was an organ donor, they might not help me or save my organ donor, they might not help me or save my life if they know they can get my organs.”life if they know they can get my organs.”

Organ Donation MythsOrgan Donation Myths

““I can’t have an open casket funeral if I am I can’t have an open casket funeral if I am an organ donor.”an organ donor.”

““It will cost my family or my estate too It will cost my family or my estate too much if I am an organ donor.”much if I am an organ donor.”

““It’s against my religion.”It’s against my religion.”

The Donor Registry The Donor Registry

Current state of registryCurrent state of registry There are 3.3 million drivers in registry.There are 3.3 million drivers in registry.

Most believe this is a legal consent for donation.Most believe this is a legal consent for donation.

The heart symbol indicates “DONOR”, not just The heart symbol indicates “DONOR”, not just heart donor.heart donor.

Registries and laws are different in every state.Registries and laws are different in every state.

HB1372 – The Heart PrevailsHB1372 – The Heart Prevails Legislation introduced in April 2007 by donor Legislation introduced in April 2007 by donor

dad and Rep. Dale Folwell (R- WS)dad and Rep. Dale Folwell (R- WS)

Leg. Adopted from UAGA.Leg. Adopted from UAGA.

HB1372 creates a first person consent HB1372 creates a first person consent registry.registry.

Law became effective October 1, 2007.Law became effective October 1, 2007.

HB1372 – The Heart PrevailsHB1372 – The Heart Prevails

•Heart on the license places one into DMV donor registry.•Heart on license is LEGAL first person consent – NEXT OF KIN CAN NOT OVERRIDE.•Those already in registry are grandfathered.•Registry database is confidential – only OPOs and Eye Banks are granted access.•Donor cards are still legal consent, but there is no database for them.

HB1372 – The Heart PrevailsHB1372 – The Heart Prevails

•The heart symbol/registry indicate legal consent for ORGAN and EYE donation only – NOT TISSUE.•Registry gives consent for research•Those under 18 NEED NEXT OF KIN CONSENT (unless emancipated)•Families will always be notified of loved one’s wishes, med/soc. History.

Registry for Advance DirectivesRegistry for Advance Directives

NC Secretary of State’s OfficeNC Secretary of State’s Office Internet AccessibleInternet Accessible statewide listing statewide listing on-line access to documentson-line access to documents www.sosnc.comwww.sosnc.com N.C.G.S.§§130A-465 to 130A-471N.C.G.S.§§130A-465 to 130A-471

Documents on the RegistryDocuments on the Registry

Four Types of Documents may be Four Types of Documents may be filed in The Statewide Registry:filed in The Statewide Registry: Declaration of a Desire for a Declaration of a Desire for a

Natural Death-Living WillNatural Death-Living Will Health Care Power of AttorneyHealth Care Power of Attorney Advance Instruction for Mental Advance Instruction for Mental

Health TreatmentHealth Treatment Anatomical gift - organ donation Anatomical gift - organ donation

How the Registry WorksHow the Registry Works Registry is entirely voluntaryRegistry is entirely voluntary Confidential- need the document number Confidential- need the document number

and password to view the directives on-and password to view the directives on-lineline

Original documents are returned to each Original documents are returned to each registrant, along with a wallet-sized card registrant, along with a wallet-sized card containing a case-specific file number and containing a case-specific file number and passwordpassword

$10 fee per document $10 fee per document

For More InformationFor More Information

Legal Information and Advice

Hospice and End of Life Care Planning:

•www.carolinasendoflifecare.org

Information about Organ, Tissue and Eye Information about Organ, Tissue and Eye Donation:Donation:

www.carolinadonorservices.org

www.lifesharecarolinas.org

Information about Services for Adults and Seniors in your Community

www.ncdhhs.gov/aging