HEALTHCARE DIRECTIVES


Healthcare Directives
(Advance Directives):
A Gift You Can Give

If you do not have an advance directive in place and you become seriously ill or injured, your doctors, hospital staff and loved ones will do the best they can. However, without clear direction from you, your loved ones my have to guess what you would want. If there is any uncertainty about your wishes, care could be delivered that may not be consistent with your wishes. If you want people to know—and follow—your wishes, you should talk with them about your preference and have a written and signed healthcare directive/advance directive in place.


QUESTIONS AND ANSWERS

What is a Healthcare Directive?
A healthcare directive is a written declaration that allows you to:
1. Give instructions about any aspect of your healthcare.
2. Choose a person to make healthcare decisions for you.
3. Give instructions about specific medical treatments you do or do not want.
4. Give other instructions, including where you wish to die.
5. Make an anatomical gift.
 
Why should I complete a Healthcare Directive?
There may come a time when, due to your mental or physical condition, you may be unable to make your own healthcare decisions. Then your healthcare providers will look to any prior written advance directives or to family members to make decisions on your behalf. A doctor must make a determination that you are unable to make your own healthcare decisions.
 
Who can make a healthcare directive?
Any competent person 18 years of age or older.
 
Does a healthcare directive need to be in writing?
Yes. To be legally sufficient in ND, a healthcare directive must be in writing.
 
Can I revoke my healthcare directive?
Yes. As long as you remain competent, you can revoke your healthcare directive.
 
After I have signed a healthcare directive, what should I do with it?
It is a good idea to talk about your healthcare directive with your doctor and other healthcare providers, and your family, since your doctor will probably consult them in the event you are unable to make your own healthcare decisions. Copies should be given to your agent, doctor, any other health care providers, and members of your family.
 
What is an agent?
An agent is an adult that you give the authority to make healthcare decisions for you, as provided in your healthcare directive.
 
Who should I appoint as my agent?
Your agent should be someone you know and trust, who knows how you feel about medical treatment, who understands your beliefs and values, and who is willing to carry out your wishes. The appointment of an alternate agent is not required, but it is a good safeguard if something should happen to your original agent.
 
What are my agent’s responsibilities in carrying out my wishes?
Your agent is required to follow your wishes as contained in your healthcare directive. If your wishes are unknown, your agent is required to make healthcare decisions for you based on what he or she feels is in your best interest.
 
When does a healthcare directive become effective?
A healthcare directive is effective when all of the following occur:
1. You have executed a healthcare directive;
2. Your agent, if any, has accepted the position as agent in writing; and
3. Your doctor has certified, in writing, that you lack the capacity to make healthcare decisions. You lack the capacity to make healthcare decisions when you do not have the ability to understand and appreciate the nature and consequences of a healthcare decision, including the significant benefits and harms of proposed healthcare, or reasonable alternatives to that healthcare.
 
Can I still make my own healthcare decisions after I have signed a healthcare directive?
Yes. You will be able to make your own healthcare decisions as long as you are capable of doing so. Your agent’s authority starts only when your doctor certifies in writing that you do not have the capacity to make healthcare decisions.
 
Where should I keep my healthcare directive?

The original signed copy should be given to your agent or you should keep it where it is immediately available to your agent and your alternate agent, your doctor, and any other healthcare provider.
 
Can my agent or alternate agent withdraw?
Yes. An agent or alternate agent may withdraw by giving you notice prior to the time you are determined to lack capacity to make healthcare decisions. After such time, your agent or alternate agent may withdraw by giving notice to your doctor.
 
Do I need a lawyer to help me make a healthcare directive?
No. A lawyer may be helpful and you might choose to discuss these matters with an attorney, but there is no legal requirement in North Dakota to do so.
 
Whom should I talk to if I want more information or if I want to compete a healthcare directive?
1. You may talk to your attorney.
2. You may contact the social worker at Cavalier County Memorial Hospital. Healthcare Directives (Advance Directives) forms are available at the hospital. 
3. You can research information about healthcare directives at www.nd.gov/humanservices. Copies are available online.
4. You can contact ND Dept. of Human Services at 1-800-451-8693.


For reasons unknown—maybe because her mother was a former nurse—care at the end of life was an issue Jane had talked about with her parents for a long time. “It just came up really naturally,” recalls Jane, “especially as they had friends who were aging or ill, and my parents must have visited about it between them. They were very unified about what they wanted.” After Jane’s mother was hospitalized with a brain hemorrhage, Jane realized that not only had her parents “talked the talk,” but that the right paperwork had been done, too. Says Jane, “We had the legal papers—the advance directives—and I knew where they were.” Jane’s mother had also spoken with her physician about the kind of care she wanted at the end of life. “Nobody has ever been clearer with me about her wishes than your mother,” the doctor told Jane. For Jane, knowing her mother’s wishes about end-of-life care truly felt like a gift!