In your Advance Directive, you can write down your instructions and preferences about the health care that you want and do not want.  If you are incapacitated and need care, then your doctors and agent will have your input on what you authorize and refuse.  You do not have to give written directions if you have appointed an agent, but directions are helpful for both your agent and doctors.



Information, Preferences, and Instructions

There are 3 “levels” of directions that can be included in your AD.


1.  Information

This includes health conditions, medication history, and any other details that may be useful to your doctor when he/she is treating you.  With Information, you are not requesting or refusing anything – you are simply telling your doctors and agent a little more about you as a person and patient.


2.  Preferences *

You can suggest certain medications, facilities, and treatments that you would like to be used.  Writing out your Preferences will help your doctors and agent to determine what works best for you, so that your recovery can be as quick as possible.  Preferences are not legally binding; factors like time and availability may mean that your doctors will try treatments that are not “preferred.”
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3.  Instructions

Instructions are legally binding parts of your AD that your agent cannot override. Your doctor is only able to override your Instructions in a very limited number of emergency situations.  Instructions can include: medication or treatment refusals, directions for visitation, directions for end-of-life care, and directions for anatomical gifts.



Your doctors and agent have to follow your Instructions in most cases

  • ​Your agent cannot authorize or refuse treatment that conflicts with the Instructions that you have written in your AD.
  • Your health care providers cannot treat you in a way that conflicts with your Instructions UNLESS there is a separate legal authority to treat you differently.



For example, you may write in your Instructions that you refuse to consent to inpatient psychiatric treatment.  Refusing to consent does not prevent someone from seeking your involuntary commitment to a psychiatric facility.  It also does not prevent a court from ordering your commitment to a facility and your treatment in that facility. 



A doctor is not required to follow your Instructions if he/she finds that your Instructions are: 

  • Medically inappropriate
  • Ethically inappropriate
  • Illegal



If your doctor cannot treat you for one of the above reasons, he/she is still required to:

  • Tell you or your agent of his/her finding and the reasons for it.
  • Make a “reasonable effort” to transfer you to another physician who is willing to follow your Instructions.
  • Continue to provide care, within the bounds of what he/she finds to be medically and ethically appropriate.See Va. Code § § 54.1-2990.



*  It is helpful to include explanations of why you prefer certain treatments, medications, or facilities; doing this will help your doctors to better understand what care you need in order to recover.  Explaining your Preferences also makes it more likely that doctors will follow them.

Giving Written Instructions