North Carolina Estate Planning Blog : North Carolina Estate Planning Lawyer & Attorney : Trust Counsel, PA : Trust Administration : Serving Chapel Hill, Durham, Raleigh, Pittsboro, Orange County, Chatham County

Most people who execute living wills, health care powers of attorney and other advance directives express their desire to not have their lives prolonged if terminally ill or in a persistent vegetative state. 

However, there are some who believe that all or many measures should be taken to prolong their lives.  The North Carolina statutory documents are not really designed for this purpose.  Thanks to a client, I recently discovered the "Will to Live" Durable Power of Attorney, which is designed for persons who want to be kept alive by artificial nutrition hydration and nutrition, as well as other life-prolonging measures under most circumstances.

This document does meet the NC statutory requirements.  Just as with the standard living will, I would encourage those who are interested in using it to discuss it with both their physician and their estate planning attorney.

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The website of the North Carolina Medical Board contains many Position Statements, including one on Advance Directives, a portion of which is quoted below:

"It is the position of the North Carolina Medical Board that it is in the best interest of the patient and of the physician/patient relationship to encourage patients to complete or authorize documents that express their wishes for the kind of care they desire at the end of their lives. Physicians should encourage their patients to appoint a health care agent to act through the execution of a Health Care Power of Attorney and to provide documentation of the appointment to the responsible physician(s)."

and one on Pain Management and End-of-Life Care:

"The Medical Board will assume opioid use in such patients is appropriate if the responsible physician is familiar with and abides by acceptable medical guidelines regarding such use, is knowledgeable about effective and compassionate pain relief, and maintains an appropriate medical record that details a pain management plan." and

"The health care team should give primary importance to the expressed desires of the patient tempered by the judgment and legal responsibilities of each licensed health professional as to what is in the patient’s best interest. "

Those with an interest in these issues would be well-advised to read the Position Statements and discuss them with their physicians.

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2010 marks the 20th Anniversary of the enactment of the Patient Self-Determination Act, and April 16th, 2010 is the Third Annual National Healthcare Decisions Day.

So, make sure that you, your family and friends all have up-to-date Health Care Powers of Attorney, Advance Directives (Living Wills) and Authorizations for Use and Disclosure of Protected Health Care Information (HIPAA Authorizations) It's also important to talk your doctor and family about your wishes.

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In addition to attorney-prepared health care planning documents like Health Care Powers of Attorney, Living Wills and HIPAA Authorizations, I often talk to clients about Do Not Resuscitate (DNR) Orders and the newer Medical Order Scope of Treatment (MOST) Form.  These two forms can be obtained only from one's physician, and must be signed by the physician to be valid.

Laypersons often get Living Wills and DNRs confused, and many physicians are unaware of the MOST form.  For those who are elderly or seriously ill, a conversation with one's physician about whether or not to use a DNR or MOST is in order.  The North Carolina Medical Society's website contains quite a bit of information and sample forms.

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Make Time to Create an Advance Medical Directive - I recently had the opportunity to hear a presentation by Bill Colby, the attorney who represented Nancy Cruzan's family in the right-to-die case that went all the way to the U.S. Supreme Court.  Mr. Colby has written a book Unplugged: reclaiming our right to die in America, which I have purchased but have not yet read.  If Mr. Colby writes as well as he speaks, it should be an interesting and information book.

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