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Advance Directives

The Living Will and The Medical Power of Attorney

United Hospital Center is committed to providing you with the care you would want to receive. Among your rights as a patient is the right to make decisions concerning your health care. You have the right to accept or refuse medical and/or surgical treatment. To make these decisions, it is best to consider what is important to you and to discuss these decisions with your famiIy, friends, and doctor.

Your Right to Make Decisions About Your Care

You also have the right to give directions to your family and physicians about the health care you would want in the future if you become unable to make decisions for yourself. These directions are best given in written documents called "advance directives".

West Virginia has two forms of written advance directives which are recognized by state law:  Living Will and the Medical Power of Attorney. A Living Will tells your doctor what treatments you would want if you were dying. A Medical Power of Attorney tells your doctor who you would want to make health care decisions for you if you could not make them for yourself. A Medical Power of Attorney also allows you to give specific instructions to your doctor about your health care.

If you have not already completed one or both of these documents, the hospital encourages you to consider doing so prior to or shortly after your admission. If you would like assistance, please let your doctor or nurse know, and they can arrange for you to complete your Living Will or Medical Power
of Attorney.

Completion of a Living Will or a Medical Power of Attorney is voluntary, and is not necessary for your admission to the hospital or for your continued stay in the hospital.

United Hospital Center's policy recognizes a patient's right to complete a Living Will or a Medical Power of Attorney. It is the hospital's policy that these documents be respected by hospital personnel.

What Are "Advance Directives for Health Care Decisionmaking"? Why Are These Important?

You have the right to make your own health care decisions. You may expect your doctor and other health care providers to tell you about the nature of any proposed procedure or treatment, its probable benefits or effects and any predictable discomfort, complications or risks. You have the right to know alternative treatments and the risks and benefits. You have the right to ask questions and you have the right to decide whether you want the treatment or not. Your right to accept medical or surgical treatment also includes the right to refuse it.

What if because of injury or illness, you become incapable of making health care decisions for yourself'? For example: Imagine you are in a hospital terminally ill with cancer and you are confused. Who should decide whether you have cardiopulmonary resuscitation if your heart should stop suddenly? What if you are 40 years old and are involved in a motor vehicle accident which leaves you permanently unconscious. Who will decide whether you are to be kept alive with tube feedings? What if you have Alzheimer's Disease and you are in a nursing home and you develop a serious Infection. Who will decide whether or not you will be hospitalized and treated with antibiotics?

"West Virginia Law Recognizes Two Types of Advance Directives. . . Living Will and Medical Power of Attorney."

Even if you cannot decide for yourself, you can remain in charge of your health care by creating a document called an "advance directive." West Virginia law recognizes two types of written advance directives for health care decision making:  Living Will and Medical Power of Attorney. The following pages present Information about these directives and include the necessary forms.

You may use these documents to let your family and doctor know your decisions for health care, if you become unable to decide for yourself. You may also appoint someone you know and trust as your health care representative to ensure that your choice or decision is honored.

Decisions about the type of treatment you would want in the future can be difficult to make. Before you create either a Living Will or Medical Power of Attorney. You may find it helpful to discuss your health care preferences and options with your family, friends, doctor or religious counselor.

Frequently-Asked Questions About Advance Directives

1. What is a Living Will?

A Living Will is a document that directs your doctor to withhold or withdraw life-prolonging interventions (such as cardiopulmonary resuscitation, kidney dialysis or machines to help you breath). If you are terminally ill or in a persistent vegetative state (permanently unconscious), a Living Will tells your doctor to provide only those treatments that will relieve pain and provide comfort. You may add other special directives or limitations to your Living Will.

A copy of the Living Will form is included at the end of this page. You may create a Living Will by printing, filling out this form and having it properly witnessed and notarized.

2. What is a Medical Power of Attorney?

Medical Power of Attorney is another type of advance directive which allows you to name a person to make health care decisions for you if you are unable to make these for yourself.

A copy of the Medical Power of Attorney form is available upon request by calling 681-342-1740. You may create a Medical Power of Attorney by filling out this form and having it properly witnessed and notarized.

3. How is the Medical Power of Attorney different from the Living Will?

Living Will only applies if you are terminally ill or in a persistent vegetative state. It only tells your doctor what you do not want, unless you write in other specified instructions.

The Medical Power of Attorney allows you to appoint someone to make health care decisions for you, if you are unable. It covers all health care situations in which you are incapable of making decisions for yourself. It also allows you to give specific instructions to your representative about the type of care you would want to receive.

The Medical Power of Attorney allows your representative to respond to medical situations that you might not have anticipated and to make decisions for you with knowledge of your values and wishes.
Since the Medical Power of Attorney is more flexible. It is the advance directive most people choose. Some people; however, do not have someone whom they trust or who knows their values and preferences. In this circumstance a Living Will should be considered.

4. I am a young person in good health. Do I really need to create a formal Advance Directive?

Advance Directives are for all persons. We never know when an accident or serious illness will leave us incapable of making our own health care decisions.

5. What if I already have a Living Will? Do I need to create a Medical Power of Attorney?

It Is not uncommon for people to create both a Medical Power of Attorney and a Living Will. Since the Medical Power of Attorney is a more flexible document, and it allows you to name someone to make decisions for you, it is advisable to create a Medical Power of Attorney even if you have already signed a Living Will. The representative you appoint as your Medical Power of Attorney, can help see that the preferences expressed in your Living Wil1 are carried out.

If you choose to sign both documents, it is recommended to store these together in the same place. This helps to assure that your representative will know to respect all of your wishes.

6. Can I still make my own health care decisions once I have created an Advance Directive?

Yes. You have the right to make your own health care decisions as long as you are able to do so. Your Advance Directive becomes effective only when you are incapable of expressing your own preferences.

7. If I decide to create a Medical Power of Attorney, how should I choose my representative?

Choose as your representative, someone who knows your values and wishes, and someone whom you trust to make decisions for you. Do the same for a successor representative. Ask both to be sure they understand and agree to be your representative.

Your representative may be someone who will inherit from your estate. You may, but do not have to choose a famtly member to be your representative. Regardless of your choice, your representative should be someone who is likely to be available if needed, and who will decide matters the way you would decide. Name only one person each, as your representative and your successor representative. Do not choose as your representative or successor representative your doctor or another person who is likely to be your future health care provider.

8. What instructions should I give my representative concerning my health care?

You may give very general instructions and preferences or be quite specific. Though not required, it would be helpful to your representative to have directions from you about life-prolonging intervention, particularly artificially supplied food and water (tube feedings), cardiopulmonary resuscitation (CPR), the use of dialysis. machines to help you breathe, and organ and tissue donation.

Many people choose to write their representative a letter stating their personal values and wishes, their feelings about life and death, and any specific instructions. Attaching a copy of this letter to the Medical Power of Attorney is also common.

9. Can any person create an Advance Directive?

Yes. Any person who has the capacity to make decisions for himself or herself can create an Advance Directive.

10. Do 1 need a lawyer to create an Advance Directive?

No. Both the Medical Power of Attorney and Living Will can be created
without the assistance of a lawyer.

11. Who should be the witnesses to my signature on my Advance Directive?

The qualifications for the witnesses are printed on both the Medical Power of Attorney and Living Will forms. Your witnesses must be at least 18 years of age and not related to you by blood or marriage. Choose persons as witnesses who will not inherit any of your property. Do not choose your representative. your successor representative or your doctor as your witness.

12. How can l find a Notary Public to complete my Medical Power of Attorney form?

Businesses such as banks, Insurance companies, government offices, hospitals, doctors' offices and automobile associations have or can direct you to a notary public.

13. What should I do with my Advance Directive after I sign it?

After your Advance Directive Is signed, witnessed and notarized, give one copy each to your representative, to your successor representative and to your doctor. Keep the original document In a safe location where It can be easily found. Your safety deposit box may not be the best place for your Advance Directive unless you are certain someone close to you has access to the safety deposit box If you become Incapacitated.
Make sure your representative knows where the oJiglnalls so It can be shown to your doctor on request. However, a photocopyofyourAdvance Directive Is legally valid.

14. What i fmy doctor or my family do not agree with my treatment choices or health care decisions?

Consent to and refusal of health care Is your right. If you have made your wishes known In an Advance Directive, your doctor and your representative must respect those wishes. If your doctor cannot comply with your wishes, he or she must transfer your care to another doctor.

If you have appointed someone as your representative under a Medical Power of Attorney, that person's consents and refusals on your behalf are as meaningful and valid as your own. The wishes of other family members do not override your own clearly expressed choices or those made by your representative on your behalf.

15. Do I have to sign an Advance Directive to receive health care treatment?

No doctor or other health care provider may require creation of an Advance Directive as a condition for you to receive services.

16. Will another state honor my Advance Directive?

Laws differ somewhat from state to state. but In general. a patient's expressed wishes will be honored. No law or court has invalidated the concept of Advance Directives. and an increasing number of statutes and court decisions support it.

17. What if I change my mind about who I want to be my representative or about the kind of treatment I want?

You should review your Advance Directive periodically to make sure it still reflects your wishes. The best way to change your Advance Directive Is to create a new one. The new Advance Directive will automatically revoke the old version. Be sure to notify all people who have copies of your Advance Directive that you completed a new one. Collect and destroy all copies of the old version.

18. How can I be sure that the wishes expressed in my Advance Directive will be followed?

Be sure your doctor has a current copy. Bnng a copy with you If you are admitted to a health care facility. Tell people where you keep your Advance Directive.

Print, cut out and complete the wallet cards on the inside back cover of this booklet. indicating where your Advance Directive can be found. Put one card in the purse or wallet you carry with you most often. Keep the second card on your refrigerator. in your motor vehicle glove compartment. a spare purse or wallet, or other easy-to-find place.

19. How can I get more copies of the Advance Directives forms and booklet?

You may call the Office of Geriatrics and Long-Term Care. West Virginia Department of Health and Human Resources. at (304) 348-2363 between 9:00 a.m. and 4:30 p.m. weekdays. ory ou may wrtte: Office of Geriatrics and Long-Term Care. Department of Health and Human Resources. Building 6. Room 850. State Capitol Complex. Charleston. West Virginia 25305.

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