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Medical Care Decisions - A Summary of Hospital Policy
We recognize that individuals have the right to make decisions concerning
their medical care. These decisions should be made after careful consultations
with physicians, family members, attorneys, and/or other advisers. The
best way to ensure that your wishes regarding medical care are complied
with is through specific, ongoing discussions with your physician who
orders medical treatment.
In addition, federal law (the Patient Self-Determination Act) requires
that we provide you with information on self-determination, including
the right to accept or refuse medical treatments. Below is a summary of
how we will act to see that your wishes are complied with in accordance
with law, your physician's orders, and our mission and philosophy:
1. This information sheet and an information sheet provided by the state
of North Carolina will be
given to each adult admitted to the hospital.
2. A nurse will ask, as part of her information gathering interview with
you, whether you have executed a living will, a power of attorney for
health care, or any other "advance directives."
3. If you do have an advance directive, we will ask for a copy and will
put it in your medical record; we will also give a copy to your physician.
4. If you do not have an advance directive, but want more information or
assistance in getting one, we will provide printed materials and try to
answer questions you may have (or direct you to an appropriate source
for an answer).
5. If you wish to execute an advance directive, we will assist you.
6. We will comply with the directions given in your advance directive in
accordance with applicable laws, your physician's orders, and the
hospital's mission and philosophy.
It is IMPORTANT to us that you know the following:
1. We will do our best to comply with your wishes concerning medical care
(as understood and ordered by your physician) whether or not you have
a written advance directive.
2. It is not necessary that you have an advance directive in order to receive
treatment at Iredell Memorial. We will give you the same level of compassionate,
conscientious care whether you have a written advance directive or not.
3. We (and your physician) need to know whenever you have an advance directive
and whether you
have changed it or revoked it.
If you have any questions about advance directives or hospital policy,
please call extension 3500 or 3501 (Administration) between the hours
of 8:30 AM. and 5:00 PM, weekdays.
You also have the right to voice any concerns about our handling of advance
directive matters to the North Carolina Division of Facility Services
Complaint Section at (800) 662-3004.
Medical Care Decisions & Advance Directives
What You Should Know
This information was developed by the North Carolina Division of Medical
Assistance in cooperation with the Department of Human Resources Advisory
Panel on Advance Directives in 1991. Revised 1999.
What are my rights?
Who decides about my medical care or treatment?
If you are 18 or older, married or legally emancipated and have the capacity
to make and communicate health care decisions, you have the right to make
decisions about your medical/mental health treatment. You should talk
to your doctor or other health care provider about any treatment or procedure
so that you understand what will be done and why. You have the right to
say yes or no to treatments recommended by your doctor or mental health
provider. If you want to control decisions about your health/mental health
care even if you become unable to make or to express them yourself, you
will need an "advance directive."
What is an "advance directive"?
An advance directive is a set of directions you give about the health/mental
health care you want if you ever lose the ability to make decisions for
yourself. North Carolina has three ways for you to make a formal advance
directive. One way is called a "living will'; another is called
a "health care power of attorney"; and another is called an
"advance instruction for mental health treatment."
Do I have to have an advance directive and what happens if I don't?
Making a living will, a health care power of attorney, or an advance instruction
for mental health treatment is your choice. If you become unable to make
your own decisions, and you have no living will, advance instruction for
mental health treatment, or a person named to make medical/mental health
decisions for you (health care agent), your doctor or health/mental health
care provider will consult with someone close to you about your care.
What is a living will?
In North Carolina, a living will is a document that tells others that you
want to die a natural death if you are terminally and incurably sick or
in a persistent vegetative state (coma or irreversible advanced dementia)
from which you will not recover. In a living will, you can direct your
doctor not to use heroic treatments that would delay your dying, for example
by using a breathing machine ("respirator" or "ventilator"),
or to stop such treatments if they have been started. You can also direct
your doctor not to begin or to stop giving you food and water through
a tube ("artificial nutrition or hydration").
Health Care Power of Attorney
What is a health care power of attorney?
In North Carolina, you can name a person to make medical/mental health
care decisions for you if you later become unable to decide yourself.
This person is called your "health care agent." In the legal
document you name who you want your agent to be. You can say what medical
treatments/mental health treatments you would want and what you would
not want. Your health care agent then knows what choices you would make.
How should I choose a health care agent?
You should choose an adult you trust and discuss your wishes with the person
before you put them in writing.
Advance Instruction for Mental Health Treatment
What is an advance instruction for mental health treatment?
In North Carolina, an advance instruction for mental health treatment is
a legal document that tells doctors and health care providers what mental
health treatments you would want and what treatments you would not want
if you later become unable to decide yourself. The designation of a person
to make your mental health care decisions, should you be unable to make
them yourself, must be established as part of a valid Health Care Power
How do I make an advance directive?
You must follow several rules when you make a formal living will, health
care power of attorney, or an advance instruction for mental health treatment.
These rules are to protect you and ensure that your wishes are clear to
the doctor or other provider who may be asked to carry them out. A living
will, a health care power of attorney, and an advance instruction for
mental health treatment must be written and signed by you while you are
still able to understand your condition and treatment choices and to make
those choices known. Two qualified people must witness all three types
of advance directives. The living will and the health care power of attorney
also must be notarized.
Are there forms I can use to make an advance directive?
Yes. There is a living will form, a health care power of attorney form,
and an advance instruction for mental health treatment form that you can
use. These forms meet all of the rules for a formal advance directive.
Using the special form is the best way to make sure that your wishes are
When does an advance directive go into effect?
A living will goes into effect when you are going to die soon and cannot
be cured, or when you are in a persistent vegetative state (coma or irreversible
advanced dementia). The powers granted by your health care power of attorney
go into effect when your doctor states in writing that you are not able
to make or to make known your health care choices. When you make a health
care power of attorney, you can name the doctor or mental health provider
you would want to make this decision. An advance instruction for mental
health treatment goes into effect when it is given to your doctor or mental
health provider. The doctor will follow the instructions you have put
in the document, except in certain situations, after the doctor determines
that you are not able to make and to make known your choices about mental
health treatment. After a doctor determines this, your Health Care Power
of Attorney may make treatment decisions for you.
What happens if I change my mind?
You can cancel your living will anytime by informing your doctor that you
want to cancel it and destroying all the copies of it. You can change
your health care power of attorney while you are able to make and make
known your decisions by signing another one and telling your doctor and
each health care agent you named of the change. You can cancel your advance
instruction for mental health treatment while you are able to make and
make known your decisions, by telling your doctor or other provider that
you want to cancel it.
Whom should I talk to about an advance directive?
You should talk to those closest to you about an advance directive and
your feelings about the health care you would like to receive. Your doctor
or health care provider can answer medical questions. A lawyer can answer
questions about the law. Some people also discuss the decision with clergy
or other trusted advisors.
Where should I keep my advance directive?
Keep a copy in a safe place where your family members can get it. Give
copies to your family, your doctor or other health/mental health care
provider, your health care agent and any close friends who might be asked
about your care should you become unable to make decisions.
What if I have an advance directive from another state?
An advance directive from another state may not meet all of North Carolina's
rules. To be sure about this, you may want to make an advance directive
in North Carolina too. Or you could have your lawyer review the advance
directive from the other state.
Where can I get more information?
Your health care provider can tell you how to get more information about
advance directives by contacting:
IREDELL MEMORIAL HOSPITAL
Extension 3500, or