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Advance Care Planning

A Guide to Advance Directives

An advance directive helps avoid confusion and lets you have a say in the kind of care you receive if there ever comes a time when you can’t make healthcare decisions for yourself. Adults 18 and older have the legal right to create an advance directive.

Advance care planning is a process that prepares you to complete an advance directive. You can also see and download this guide:

Here’s what you need to know before you fill out the advance directive form.

Stop: Before You Fill Out an Advance Directive Form

Many people don’t realize all the things that need consideration. Advance care planning involves deciding:

  • Who will make healthcare decisions for you, if you can’t
  • What kind of medical care you want in certain situations

These are important decisions. Take time to understand what decisions you might need to make. Reflect on your personal experiences, goals, values, and preferences. Then, communicate with your healthcare decision-makers, other people close to you, and your healthcare team.

Why Should You Plan in Advance?

You may face a time, due to injury or illness, when you can't communicate what you want. That means you won’t be able to make your own healthcare choices. You’re leaving the control up to others.

That’s where advance care planning comes in. You make a plan ahead of time and share it. That way you get the care you choose even when you can't tell us yourself.

Phrases to Know

  • Advance care planning: guides you through the process of making these choices for your healthcare
  • Advance Directives or Advance Medical Directives: legal documents that communicate your healthcare choices
  • Health Care Agent: the person you appoint to make healthcare decisions for you if you can’t do it yourself

What You Need to Decide & Do: The Advance Care Planning Process

Advance care planning involves:

  1. Carefully choosing a good healthcare decision-maker or Health Care Agent
  2. Thinking about the kind of care you want in certain situations
  3. Completing an advance directive form and signing it in front of 2 witnesses
  4. Discussing your decisions with your family, caregivers, and friends
  5. Giving copies of your completed, signed, and witnessed forms to UVA Health

Step 1: Choosing a Health Care Agent

The person you appoint as your Health Care Agent should make the same decisions for you that you would make for yourself if you could. Knowing what matters most to you will help your Health Care Agent make those decisions for you, giving you control over the healthcare you receive.

How Do I Choose a Health Care Agent?

When choosing a Health Care Agent, pick someone who:

  • Is willing to speak up for you when you can’t
  • Is willing to discuss the kind of care you’d want if you were seriously ill and not expected to recover
  • Will respect and follow your decisions
  • Can think and communicate clearly in stressful times
  • Can make sure your loved ones and healthcare team understand your choices

What Should My Healthcare Agent Know?

Talk with your Health Care Agent about any experiences you’ve had with people who’ve been seriously ill and what you’ve learned from those experiences. This can help you reach your own decisions about your care.

Tell your Health Care Agent what kind of physical and mental function you need in order to have a good enough quality of life. You may want all possible medical treatments if those treatments can help you recover well. But if a good recovery isn’t likely or treatment becomes too hard, you might want your care to focus on comfort and quality of life instead of living longer.

Why Do I Need a Health Care Agent?

If you don’t name a Health Care Agent in a legal document, and you don't have a court-appointed guardian, Virginia law lists those responsible for your healthcare decisions in this order:

  1. Your spouse (even if you're separated, unless a divorce is filed with the court)
  2. Your adult children (all must agree)
  3. Your parents (both must agree)
  4. Your adult siblings (all must agree)
  5. Other blood relatives (like aunts, uncles, nieces, nephews, or cousins)

How to Officially Appoint a Healthcare Agent

You name a Health Care Agent in an advance directive form. This may also be called a Healthcare Power of Attorney. You must sign the advance directive in front of 2 adults. They must also sign the document. 

Step 2: Make Your Healthcare Choices

You’ve named a Health Care Agent. Now it’s time to choose the medical treatments you want in certain situations. Your Agent can help you consider your options.

Questions that you might talk about include:

  • If you become very ill and treatment isn't likely to lead to a good recovery, would you prefer care focused on giving you more time or care focused on pain relief and symptom control for a better quality of life?
  • What abilities are so important that you can't imagine living without them?
  • What experiences have you had with people who’ve been seriously ill and what have you learned from those experiences?
  • What are your biggest fears and worries about your health?
  • What would your most important goals be if you were seriously ill and not expected to make a good recovery?
  • What does a good recovery look like to you?

Always make sure everyone understands exactly what your choices mean when thinking through or discussing specific healthcare situations.

Step 3: Fill Out an Advance Directive

If you only want to name a Health Care Agent, then complete the Health Care Agent Only form.

If you want also to provide decisions about healthcare, complete the Standard Advance Directive, which allows you to do both:

  • Name a Health Care Agent
  • Provide your healthcare decisions

Sign the form in front of 2 adults and have them both sign as witnesses.   

Step 4: File the Form with UVA Health

If we don’t have your advance directive form, we can’t follow your plan. Make sure that you file your advance directive with us and with any other of your healthcare providers.

You can:

  • Give a copy to a registration team member at your next clinic visit
  • Give a copy to your doctor, nurse, or social worker at your next inpatient visit
  • Upload to MyChart using the MyChart ACP page

Make sure your Health Care Agent and other important people have a copy. 

Step 5: Discuss Your Decisions With the People in Your Life

An upfront conversation with the people in your life can prevent confusion in case of an emergency.

Our advice: Review and share copies of your advance directive with the important people in your life. Make sure everyone understands:

  • The identity of your Health Care Agent
  • Where your forms are filed
  • The choices you’ve made

What if You Change Your Mind?

Your healthcare decisions are always up to you. You may change your mind about your healthcare choices over the course of your life. If you do change your mind, you should complete a new advance directive. Trying to change an existing advance directive may make the document invalid. The advance directive we will follow is the one dated most recently. 

We recommend looking at your advance directive on a regular basis to make sure it’s still what you want.

Review your advance directive when you:

  • Experience the death of someone close to you (you may have learned important things about yourself from that experience)
  • Divorce (this may affect your choice of a Health Care Agent)  
  • Get a serious diagnosis
  • Have a decline in your mental or physical health
  • Haven't reviewed it in the past 10 years

If you complete a new advance directive, be sure to give us the most recent version, so we can get it into your medical record. 

Advance Care Planning at UVA Health

At UVA Health, we respect your healthcare choices. We’re committed to respecting advance directives outlining your choices for treatment and care. We put the patient at the center of all we do. That means every patient – including you.