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Advance Directives and Decision Making
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Advance Care Planning

Everyone has a right to choose for themselves the kind of healthcare they prefer. The only way we can be sure that our preferences are carried out is by talking them over with our family, friend and physicians and by writing them down so that they are available in the future. Virginia has a special form that you may complete to guide doctors and other healthcare providers if you are unable to make you wishes known directly.  It includes several sections:

 

OPTION l: Appointment of My Agent

This is sometimes called a health care power of attorney or health care proxy which allows you choose someone you trust to take care of your healthcare decisions in case you are unable to make those decisions yourself. You might want to pick a family member or friend who is comfortable talking to doctors.

 

OPTION ll: Powers of My Agent

This section outlines your healthcare preferences, letting your family and health care providers know what procedures and treatments you would want provided to you – and under what conditions. Maybe you want everything done to extend your life if you become ill or are in a serious accident that prevents you from breathing on your own. Maybe you prefer to be kept pain-free and comfortable if your doctor tells you that you have an incurable disease. Whatever you decide can be included in this document.

 

OPTION lll: My Healthcare Instructions

This section allows you to "specifically direct” that a defined healthcare intervention is included OR excluded from your healthcare options in the future.You get to write into the form the actual intervention about which you are making a choice.

 

OPTION lV: My End of Life Instructions

This section allows you to direct the type of care you prefer if you become terminally ill. You may choose to avoid "life-prolonging” procedures allowing the illness to run its normal course resulting in a natural death and request comfort care to relive any unpleasant symptoms.
 
You may also write in specific instructions about cardiopulmonary resuscitation (CPR), artificial hydration and nutrition (such as IVs or feeding tubes). On the other hand, you may also cross out this entire section if you prefer that everything possible should be done to keep you alive.This is an important choice so talk it over with family and friends as well as your physician.

 

OPTION V: Appointment of An Agent To Make An Anatomical Gift or Organ, Tissue or Eye Donation

This section allows you to write instructions about organ donation and, as with all the sections above it is completely optional, meaning you can cross through any section that does not say what you want it to say.
 
My Right to Revoke:
At the very end of the document you must sign to affirm the choices you have made and to indicate that you understand you can change your mind on all or any part of the form at any time. Two witnesses are required to sign the document with you.
 
Click here for the Virginia Advance Medical Directives form
 
Other Virginia resources you may find helpful:
 
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