Advance Health Care Planning and Organ and Tissue Donation: What You Need to Know

1. Advance Health Care Planning and Organ and Tissue Donation: What You Need to Know

2. What is an advance medical directive? • Allows you to retain control over whether your life will be prolonged by certain medical procedures if you have a medical condition that will result in death in a short period of time • Documents your wishes in advance if you are unable to speak for yourself • Two main documents: health care power of attorney and living will

3. What is a Health Care Power of Attorney (HCPOA)? • Legal document • Grants your health care agent the power to make medical decisions for you if you are not competent or if you are not able to communicate your wishes. • Can also give agent ability to make organ and tissue donations following your death. • Completely Voluntary -No legal requirement to execute a HCPOA

4. What is a living will • Written Document • Sets forth your wishes to withhold or withdraw life-prolonging measure in certain situations • Completely Voluntary -No legal requirement to execute a living will

5. NC Passes SL 2007-502 • In response to the Terri Schiavo case, the NC: • Bar Association, • Medical Society, • Hospital Association, • Health Care Facilities Association and • Carolinas Center for Hospice • began a work group to draft clarification of NC living will and health care POA law • House Bill 634 was drafted

6. Revisions of NC Laws • New Living Will form • New HCPOA form • New MOST form- physician order • Informed consent law- clarification of order of who can consent • Effective October 1, 2007 • Old forms remain valid

7. Living Wills– When do they apply? • Old triggering standards: Terminal and incurable or Persistent Vegetative state

8. Living Wills– When do they apply? • New Triggering standards: • An incurable or irreversible condition that will result in death within a relatively short period of time; OR • Unconscious and to a high degree of medical certainty, will never regain consciousness; OR • Suffers from advanced dementia or any other condition resulting in the substantial loss of cognitive ability and that loss, to a high degree of medical certainty, is not reversible

9. Living Wills- What do they direct? • New Law- • Withdrawal of “life-prolonging measures” Interventions which serve only to artificially postpone the moment of death by sustaining, restoring or supplanting a vital function, including mechanical vent., dialysis, antibiotics, artificial nutrition & hydration, etc. (basically unchanged)

10. MOST Form • Medical Orders for Scope of Treatment (MOST) • MOST vs. DNR • MOST vs. Advance Directives • Doctor and Patient/Patient Rep signs • Medical order – instructs other medical providers what level of care to provide to patient • TRUMPS LIVING WILL & HCPOA

11. MOST Form • Medical Orders for Scope of Treatment • Physician order sheet based on: • Patient’s medical condition • Patient’s wishes • Similar to Portable DNR • travels with PT EXCEPT: • Includes greater detailed wishes, including the right to request CPR • Must be signed by MD and PT or PT Agent • Must be updated at least once a year

12. When is MOST Appropriate? • Terminal illness • Advanced disease • Prognoses is death within a year • Debilitating chronic progressive illness

13. Purpose of MOST • Improve implementation of advance care planning by: • Communicating patient’s preferences for end of life care treatment across treatment settings • Encouraging discussion of wishes among patient, doctor, family, or surrogate

14. Benefits of MOST • Promotes patient autonomy by documenting treatment preferences and converting them into MD orders • Clarifies treatment intentions and minimizes confusion regarding patient’s preferences

15. The Health Care Power of Attorney • Section 5 • Is more specific in allowing you to express special provisions and limitations • Options to limit authority: • regarding hydration and nutrition • mental health care decisions • Individual limitations important to you • Autopsy and disposition of remains

16. The Health Care Power of Attorney • Section 6 • You may grant authority to donate organs/body

17. The Health Care Power of Attorney Section 7- Guardianship Provisions - You nominate your health care agent as guardian - Guardian must follow • GS 35A-1201(a)(5):

18. Health Care Agent vs. Guardian • Old Law: Guardian trumped HC Agent. Once guardian appointed, HCPOA ceased to be effective. • New Law: HCPOA still effective and HC agent still has authority UNLESS Guardian petitions Ct and Ct rules in Guardian’s favor

19. What authority is given to the agent for organ and tissue donation? • No authority is given unless you indicate you desire • Authority may be given for: • Any needed organs or parts • Only certain organs or parts • Body for anatomical study • You may also insert special limitations regarding such donations.

20. Why is this important? • Right Now: Nearly 3000 people waiting for an organ transplant in North Carolina • Thousands of people die each year in the United States awaiting a suitable donor organ

23. Organ Donation Myths • “I’m too old to be an organ donor.” • “They wouldn’t want my organs – I have too many medical problems.” • “They only take hearts, kidneys and livers – and mine aren’t good!” • “It the doctors or the hospital knew I was an organ donor, they might not help me or save my life if they know they can get my organs.”

24. Organ Donation Myths • “I can’t have an open casket funeral if I am an organ donor.” • “It will cost my family or my estate too much if I am an organ donor.” • “It’s against my religion.”

25. The Donor Registry

26. Current state of registry • There are 3.3 million drivers in registry. • Most believe this is a legal consent for donation. • The heart symbol indicates “DONOR”, not just heart donor. • Registries and laws are different in every state.

27. HB1372 – The Heart Prevails • Legislation introduced in April 2007 by donor dad and Rep. Dale Folwell (R- WS) • Leg. Adopted from UAGA. • HB1372 creates a first person consent registry. • Law became effective October 1, 2007.

28. HB1372 – 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.

29. HB1372 – 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.

32. Registry for Advance Directives • NC Secretary of State’s Office • Internet Accessible • statewide listing • on-line access to documents • www.sosnc.com • N.C.G.S.§§130A-465 to 130A-471

33. Documents on the Registry • Four Types of Documents may be filed in The Statewide Registry: • Declaration of a Desire for a Natural Death-Living Will • Health Care Power of Attorney • Advance Instruction for Mental Health Treatment • Anatomical gift - organ donation

34. How the Registry Works • Registry is entirely voluntary • Confidential- need the document number and password to view the directives on-line • Original documents are returned to each registrant, along with a wallet-sized card containing a case-specific file number and password • $10 fee per document

35. For More Information Legal Information and Advice

36. Hospice and End of Life Care Planning: • www.carolinasendoflifecare.org

37. Information about Organ, Tissue and Eye Donation: www.carolinadonorservices.org www.lifesharecarolinas.org

38. Information about Services for Adults and Seniors in your Community www.ncdhhs.gov/aging