Advance Directives 

As a patient, you have the right to dictate the type of treatment you receive. With an advance directive, you can put your medical wishes in writing, so your family won’t have to make decisions on your behalf. Those wishes will then be carried out by our staff.  

What is an Advance Directive? 

Advance Directives are legal documents written in advance that spell out your healthcare wishes, if you are unable to make those decisions at any time. They are an important tool giving you legal control over your medical treatment, and our team will work within our system and the law to fulfill your requests.   

Additional Information on Advance Directives

Types of Advance Directives 

Declaration of a Desire for a Natural Death (Living Will)  

A “living will” allows you to state your decisions regarding certain medical procedures unrelated to surgery. Your living will may indicate whether or not you want to be placed on a ventilator or be given a feeding tube. A directive becomes effective only after you have been diagnosed with a terminal and irreversible condition, or you are in a persistent vegetative state (permanently unconscious). 

Be sure that your physician adds your directive to your medical record. A directive can also be issued verbally to a physician if you are unable to sign a written directive. 

If you have not issued a directive and become unable to communicate after being diagnosed with a terminal or irreversible condition, your attending physician and legal guardian, or certain family members in the absence of a legal guardian, can make your decisions concerning withdrawing, withholding or providing life-sustaining treatment. Your attending physician and another physician not involved in your care can also make decisions to withdraw or withhold life-sustaining treatment if you do not have a legal guardian and certain family members are not available. 

Health Care Power of Attorney (HCPOA) 

A Health Care Power of Attorney allows you to choose an adult—an agent—who’ll be responsible for making medical decisions should you be unable to do so. That person could be a family member—a spouse, child, brother or sister—or a close friend. If you select your spouse and then become divorced, the appointment of your spouse as your agent is revoked. 

The following people cannot be appointed as your agent: 

  • Your treating healthcare provider 

  • An employee of your healthcare provider, unless he or she is related to you 

  • Your residential care provider or an employee of your residential care provider, unless he or she is related to you. 

The person you designate can only make healthcare decisions on your behalf after your attending physician declares that you are unable to make your own healthcare decisions. Your agent cannot make a healthcare decision if you object, regardless of whether you have the capacity to make the healthcare decision yourself, or whether a Medical Power of Attorney is in effect. 

Your agent must consult with your attending physician before making any decisions. These decisions can include authorizing, refusing or withdrawing treatment, even if it means that you will die. If your wishes are unknown, your agent must make a decision based on what he/she believes is in your best interest. 

South Carolina Emergency Medical Services Do-Not-Resuscitate (SC EMS DNR)  

An SC EMS DNR order gives you the option to refuse certain life-sustaining treatments that may be applied outside of a hospital, like in a nursing home or hospice situation. This Advance Directive must be issued in conjunction with your attending physician and signed by the patient (or surrogate or agent) and physician.  

Declaration for Mental Health Treatment (DMHT) 

A Declaration for Mental Health Treatment informs healthcare providers of your choices for mental health treatment, if you ever become incapacitated.  

Unlike the living will and health care power of attorney, which do not expire, the DMHT expires 3 years from the date that you sign it. If you are incapacitated on that date, the document continues in effect until you are again able to make your own decisions. 

Additional Information on Advance Directives 

Surrogate Decision-Maker  

If you can’t make your own healthcare decisions and lack a legal guardian or an agent through a Health Care Power of Attorney, then certain family members and others can make medical treatment decisions on your behalf. 

Legal Aspects of Advance Directives 

You do not need to get a Health Care Power of Attorney or Declaration for Mental Health Treatment notarized. A Declaration of a Desire for a Natural Death (Living Will) must be notarized. Our hospital, including all its physicians, cannot refuse admittance or treatment if you don’t have an advance directive. Also, not having an advance directive won’t have any bearing on your insurance coverage. 

Ethics Consultation

Patients and families may participate in ethical questions that arise in the course of care, including issues of conflict resolution. East Cooper Medical Center has a formal process established to address any ethical issues and dilemmas you may face. Please ask your nurse to contact the Hospital Ethics Team if you are interested in setting up a consultation.