You have the right to make all of the final decisions about the health care you receive. If you don’t want certain treatments, you have the right to refuse them, either orally or in writing. But in some situations, if you’re unconscious, badly injured or very ill, you may be unable to express your wishes to the doctor. In case you become unable to express your wishes yourself, you may wish to create a living will or a power of attorney. A living will is a document that instructs doctors not to perform certain types of treatment. A power of attorney names an agent who will make healthcare decisions on your behalf.
Health Care Decisions
You have the right to make decisions about the medical care you receive, including the right to accept or refuse medical treatment. These decisions should be made with your physician. If you are very ill or badly injured, you may not be able to communicate with your physician to make decisions.
People who care for you need to know your wishes and instructions if you are unable to make decisions for yourself. The best way to express your wishes and make sure they are followed is with advance directives.
It is the policy of the Greenville Health System that your health care decisions and advance directives will be respected and honored in compliance with federal and South Carolina law.
Health Care Powers of Attorney
What is a health care power of attorney? Is it different from a normal power of attorney?
A health care power of attorney is a document in which you give another person (your “agent”) the power to make decisions related to your health care. A regular power of attorney gives your agent the power to make decisions about things such as money, property, or business transactions. It will not necessarily allow your agent to make health care decisions for you. If you want an agent to be able to make health care decisions for you, you should sign a health care power of attorney no matter what other documents you have.
Is there an “official” form for the health care power of attorney in South Carolina?
Yes. The South Carolina Legislature approved a form called “Health Care Power of Attorney” in 1992. If you have questions, you are advised to contact your attorney.
Who should I appoint as my agent? What if my agent cannot serve?
You should appoint a person you trust and who knows how you feel about health care. You should also name an alternate in case your agent is unwilling or unable to serve. You should talk to the persons you choose as your agents and alternate to be sure they are willing to serve. You should also make sure they know your wishes about your health care.
What if I change my mind?
You may revoke your health care power of attorney at any time while you are competent. The method varies according to the language of the document you have used. You should ask your attorney how to revoke your specific health care power of attorney.
What is an advance directive?
An advance directive is an instruction that relates to the provision of health care if you become physically or mentally unable to make decisions. A competent adult may make an oral or written advance directive. The best way to make an oral advance directive is to tell your physician about your wishes. A written advance directive may be a living will, a health care power of attorney, or other clear written expression of your wishes.
If I do not have an advance directive, who will make health care decisions for me?
You will make those decisions if you are competent to do so. If you are unable to make health care decisions and have no advance directives, the Greenville Health System will follow the South Carolina Adult Health Care Consent Act, which provides for surrogate decision-making in the health care setting. Under this act, the possible decision makers are prioritized according to their relationship to the patient.
Written Advance Directives
When does an advance directive take effect?
These documents will be effective only if you become physically or mentally unable to make decisions. Your living will or health care power of attorney will not affect the health care you receive while you are still able to make decisions for yourself.
Who needs to know that I have an advance directive?
The decision to sign a living will form or health care power of attorney is very personal and very important. If you have questions about signing a living will or health care power of attorney, you should discuss them with your physician or your attorney. It is also advisable to discuss them with your pastor, rabbi, or religious counselor. Finally, it is very important that you discuss your feelings about your medical treatment with your family members and other people who care about you.
Do I need to bring a copy of my advance directive to the hospital?
Yes. A copy must be placed in your chart for physicians and hospital personnel to recognize it as legally valid.
What is a living will? How is it different from an ordinary will?
A living will is a document stating that you want to be allowed to die a natural death and not be kept alive by medical treatment, heroic measures, or artificial means if you are terminally ill or permanently unconscious. You would still receive medication or treatments necessary for comfort. An ordinary will is a document that tells your survivors what to do with your property after your death.
In South Carolina, “permanently unconscious” means that you are in a persistent vegetative state. This is different from a coma. A person in a coma may regain mental functioning, while a permanently unconscious person will not.
When would my living will become effective?
It would become effective when two physicians who have examined you determine that you are permanently unconscious or have a terminal condition and that your death would occur in a relatively short period of time without the use of life-sustaining procedures.
Is there a standard living will form In South Carolina?
Yes. The living will form most commonly used in South Carolina is called a “Declaration of a Desire for a Natural Death.” This “Declaration” was enacted in 1986 and revised in 1988 and 1991.
What are the requirements for signing a living will?
You must be at least eighteen (18) years old and you must be competent. At least two (2) persons, including one who is a notary public, must act as witnesses when you sign the document. If you are a patient in a hospital or a resident in a nursing home and wish to sign a living will, a representative from the Ombudsman’s Office (a division of the Governor’s Office) must be present as a witness when you sign. Persons who are not legally allowed to be witnesses are listed on the living will form. You should read the living will form carefully to be sure your witnesses are acceptable.
Is tube feeding included in the living will form?
You may indicate in spaces provided on the form whether you want to refuse nutrition and hydration, including tube feeding, if your condition is terminal or you are permanently unconscious and those procedures would only prolong your dying process. If you would like to name an agent (someone who can revoke or enforce your living will, there are spaces on the form where you can do so. Be sure to read the form carefully and follow the instructions.
Is my living will in effect if I am pregnant?
South Carolina law provides that your living will is not effective while you are pregnant.
What if I change my mind after I have signed a living will?
You may revoke a living will at any time while you are competent. There are five (5) simple ways to do so; all are explained on the living will form. You must inform your physician that you have revoked your living will in order for the revocation to be effective.
What if I have an old living will?
On June 12, 1991, South Carolina adopted a new living will form. If you signed a valid living will in South Carolina prior to that date, it is still valid. However, the old form does not say anything about permanent unconsciousness, and in most situations it does not allow nutrition or hydration to be withheld. Therefore, you should consider signing a new living will form. If you signed a living will after June 12, 1991, you should check to see if it was the new form .
Should I consider signing both a living will and a health care power of attorney?
Yes, because each document has different advantages. The living will (“Declaration of a Desire for a Natural Death”) is a form authorized by the South Carolina Legislature and is routinely recognized by physicians. It only applies to terminal conditions or permanent unconsciousness. The health care power of attorney allows your agent to decide what you would want in all medical situations including those covered in a living will.
Where should I keep my health care power of attorney and living will?
Keep the original in a safe place (probably at home) where your family members can readily find it. You should also give a copy to as many of the following people as you prefer: your family members, your physician, your lawyer, your minister, your agent. Do not put your only copy of these documents in your safe deposit box!
Are living wills and health care powers of attorney that were signed in another state also legally valid in South Carolina?
If you have a health care power of attorney or a living will that was signed in another state, you should have it reviewed by a lawyer to be sure it is legally valid in South Carolina. To be safe, you should sign the living will form approved by the South Carolina Legislature.