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In one, commonly referred to as the living will, a patient can direct that certain procedures be provided, withheld or withdrawn if the patient is terminally ill and unable to communicate directions regarding life-prolonging procedures.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 The advance directive will direct that certain life-prolonging procedures be provided, withheld or withdrawn from the patient.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