Advance Care Planning

Talking about death and other end-of-life topics is difficult.  Having conversations about advance directives may be uncomfortable, but will be beneficial when the time comes to utilize them.

An advance directive is a legal document that outlines choices about being kept alive by artificial means when suffering from a terminal illness, permanent brain damage, or advanced dementia.  Such documents are utilized when we lose decision-making capacity. While many of us have strong opinions about whether we would like to receive these types of treatments in an attempt to keep us alive, few of us actually take the steps to ensure that our wishes are honored.

Studies have found that most of us would refuse to be kept alive by artificial means if we have dementia or a terminal illness*.  Studies have also found that only 50% of terminally ill patients execute advance directives**.  However, there are several easily completed documents that will allow loved ones to understand a patient's wishes regarding end-of-life care, even if the patient lacks decision-making capacity.

The state of North Carolina recognizes two advance directive documents.  Revised in 2007, they are the Heath Care Power of Attorney and the Living Will.  These documents are legal when they are completed by an individual with decision-making capacity, signed by two witnesses, and notarized. There are also two medical orders recognized by North Carolina. They are the Do Not Resuscitate (DNR) and Medical Orders for Scope of Treatment ( MOST) forms. These forms are obtained from the physician or healthcare provider.

Health Care Power of Attorney

The Health Care Power of Attorney allows a person to name someone to make healthcare decisions for them, should the person be unable to communicate their wishes.  

Advance Directive for a Natural Death (Living Will)

The Living Will should be used as instructions for the future for anyone who would like their healthcare providers to withhold or withdraw life-prolonging measures in certain situations.  There is no legal requirement that anyone execute a living will. 

Do Not Resuscitate (DNR)

The DNR form is a medical order that communicates a person’s desire to forgo cardiopulmonary resuscitation should their heart stop beating and they stop breathing. It is utilized outside the hospital setting, and is bright yellow with a red stop sign in the middle.

Medical Orders for Scope of Treatment (MOST)

The MOST form is a medical order that describes a patient's end-of-life plan of care.  It is intended for patients experiencing a terminal illness with a prognosis of less than one year.  Since it is a medical order, any physician in any setting can follow the orders.  It is also bright pink so that it can be easily identified. 

Additional Resources

Please visit the following websites for more information about end-of-life planning:

National Hospice and Palliative Care Organization Caring Connections

Carolinas Center for Hospice & End of Life Care

North Carolina Medical Society--End of Life Resources

North Carolina Department of the Secretary of State -- Advance Health Care Directive Registry

North Carolina Department of Health and Human Services -- Division of Medical Assistance

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* SUPPORT Principal Investigators. "A Controlled Trial to Improve Care for Seriously Ill Hospitalized Patients: The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment." Journal of the American Medical Association, 274: 1591-1598.

** Degenholtz HD, Arnold RA, Meisel A, Lave JR. "Persistance of Racial Disparities in Advance Care Plan Documents Among Nursing Home Residents." Journal of the American Geriatrics Society, 50: 378-381, 2002