Providers as facilitators

The state of Virginia has strict guidelines about who can facilitate Advance Directives.  An Advance Directive is a legal document, so helping someone fill one out is the practice of law.  As a result, it is illegal for anyone other than attorneys to help people complete an AD.  There is one exception to this, however.  Va. Code § 54.1-2988 states that health care providers can help people complete Advance Directives, as well.

 

 

Honoring ADs

The Health Care Decisions Act (HCDA) outlines some of the responsibilities surrounding healthcare providers and ADs:

  • ​It is the responsibility of the health care recipient to make sure that his/her physician has a copy of – or instructions to obtain a copy of – his/her AD
  • Once a provider knows that the AD exists, it is the provider’s responsibility to note that in the person’s medical records (Va. Code § 54.1-2983)
  • No provider will be liable for carrying out an AD that the provider believes to be legitimate (Va. Code § 54.1-2985, § 54.1-2988)
  • Providers must follow a person’s AD as closely as possible, within the boundaries of the law and acceptable medical practice (Va. Code Section 54.1-2990)


For more information about the responsibilities of providers and Advance Directives, or to schedule a training with the University of Virginia to talk about these things, please contact: 


Heather Zelle, J.D., Ph.D.

Post-Doctoral Research Associate

Institute of Law, Psychiatry, and Public Policy

University of Virginia

Zelle@virginia.edu

(434) 924-8321



Benefits of ADs

Several research studies on ADs have found that healthcare providers usually find the information within ADs to be clinically appropriate and helpful, rather than restrictive (Swanson, Swartz, Elbogen et al., 2006; Wilder, Elbogen, Swanson et al., 2007).  The research shows that individuals use their ADs to account for their specific needs and preferences, not to refuse all treatments.  Individuals who complete ADs are encouraged to write down the reasons for the treatment preferences and refusals they give, so that providers will have a better understanding of their overall needs.

 

Consumers and providers agree that interventions are most successful when individuals collaborate with their providers on treatment.  During a crisis when an individual is incapacitated, this collaboration can be achieved through the use of an AD. Following an AD allows the individual to retain his/her autonomy amidst a crisis.  Additionally, research shows that knowing an individual’s treatment preferences and history allows treatment to occur more rapidly and effectively (Allen, Carpenter, Sheets et al., 2003).

 

ADs can be helpful to providers, even if they are not activated.  They are not just tools to be used when an individual is in crisis, but a repository of information that all providers would benefit from knowing about, including contact information for the individual’s specialist(s), allergies, medical history, medication refusals, and medication preferences.



Standards supporting the use of ADs

Advance Directives are supported by a few different groups and initiatives, both across the country and in Virginia, including:

  • The Joint Commission (TJC; previously, the Joint Commission on Accreditation of Healthcare Organizations)
  1. TJC requires organizations to have AD protocols in place
  2. TJC has shared that it does not believe that merely providing information about ADs is satisfactory care
  1. This plan states that advance planning should be widely and routinely used in behavioral health care
  2. This plan notes that ADs are valuable tools for preventative care and crisis management



Obtaining an individual’s AD

Here are some of the most common ways to locate an individual’s AD during an emergency:

  • Medical Records
  1. ​Electronic Medical Records typically include a “flagging” mechanism that indicates an individual has an AD, that the provider has a digital copy of the AD, or that the provider has information about how to obtain the AD


  1. Users of this registry are given a registration number and create a PIN to access their AD
  2. Users are instructed to keep a card with the registration number and PIN in their wallet or on their person
  3. Users may give access information to their close friends or family members
  4. Healthcare providers may access ADs by entering a person’s registration number and PIN


  • Physical copies
  1. The individual, his/her agent, or an emergency contact may be able to provide you with a copy of his/her AD
  2. The individual may be able to tell you where his/her AD can be located


  1. Individuals may carry a crisis card in his/her wallet or purse
  2. These cards contain information that is helpful when the individual is in a crisis – including where his/her AD is located​

Advance Directives and Health Care Providers