Advance Health Care Planning and Organ and Tissue

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

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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

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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

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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

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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

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Living Wills When do they apply?

• Old triggering standards
• ? Terminal and incurable
• or
• ? Persistent Vegetative state

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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

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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)

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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

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MOST Form

• Medical Orders for Scope of Treatment
• Physician order sheet based on
• Patients medical condition
• Patients 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

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When is MOST Appropriate?

• Terminal illness
• Advanced disease
• Prognoses is death
• within a year
• Debilitating chronic
• progressive illness

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Purpose of MOST

• Improve implementation of advance care planning
  by
• Communicating patients preferences for end of
  life care treatment across treatment settings
• Encouraging discussion of wishes among patient,
  doctor,
• family, or surrogate

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Benefits of MOST

• Promotes patient autonomy by documenting
  treatment preferences and converting them into MD
  orders
• Clarifies treatment intentions and
• minimizes confusion regarding
• patients preferences

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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

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The Health Care Power of Attorney

• Section 6
• You may grant authority to donate organs/body

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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)

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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 Guardians
  favor

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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.

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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

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Organ Donation Myths

• Im too old to be an organ donor.
• They wouldnt want my organs I have too many
  medical problems.
• They only take hearts, kidneys and livers and
  mine arent 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.

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Organ Donation Myths

• I cant 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.
• Its against my religion.

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The Donor Registry
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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.

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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.

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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.

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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 ones
  wishes, med/soc. History.

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Registry for Advance Directives

• NC Secretary of States Office
• Internet Accessible
• statewide listing
• on-line access to documents
• www.sosnc.com
• N.C.G.S.130A-465 to 130A-471

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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

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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

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For More Information
Legal Information and Advice
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Hospice and End of Life Care Planning

• www.carolinasendoflifecare.org

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• Information about Organ, Tissue and Eye Donation

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