End-of-Life situations: Your instructions for when you have a “terminal condition”
Section 54.1-2982 defines “terminal condition" as “a condition caused by injury, disease or illness from which, to a reasonable degree of medical probability a patient cannot recoverand (i) the patient's death is imminent or (ii) the patient is in a persistent vegetative state.” (emphasis added)
The “suggested” advance directive form based upon Section 54.1-2984 sets out an instruction, which you can keep, cross through, or modify, stating that, if you are found to have a terminal condition, life-prolonging procedures are to be withheld or withdrawn, and that you are to be permitted to die naturally, with only the administration of medication or the performance of any medical procedure deemed necessary to provide you with comfort care or to alleviate pain.
"Life-prolonging procedure" is defined in Section 54.1-2982 as “any medical procedure, treatment or intervention which (i) utilizes mechanical or other artificial means to sustain, restore or supplant a spontaneous vital function, or is otherwise of such a nature as to afford a patient no reasonable expectation of recovery from a terminal condition and (ii) when applied to a patient in a terminal condition, would serve only to prolong the dying process. The term includes artificially administered hydration and nutrition.” The definition goes on to state that “nothing in this act shall prohibit the administration of medication or the performance of any medical procedure deemed necessary to provide comfort care or to alleviate pain, including the administration of pain relieving medications in excess of recommended dosages in accordance with §§ 54.1-2971.01 and 54.1-3408.1. For purposes of §§ 54.1-2988, 54.1-2989, and 54.1-2991, the term also shall include cardiopulmonary resuscitation.”
Different Approaches in Different Advance Directive Forms
As noted, the “suggested” advance directive form directs that life-prolonging procedures be withheld or withdrawn if you have a “terminal condition”. You can use that instruction, scratch through it, or modify it.
The other forms cited in this website take a different approach. First, they let you address separately each of the two conditions included in the statutory definition of “terminal condition”: (1) death is imminent (coming very soon); and (2) persistent vegetative state (in a coma or otherwise unaware or unresponsive). Second, for each of these conditions they give you a set of choices as to how you want to be treated if you are in either of these conditions. One choice allows you to give your own specific instructions about how you wish to be treated.
Discussing and Understanding Your Options
It’s very important for you to review and understand your options, and to discuss them with your health care provider and your family, before completing this section. End-of-life situations will be very difficult for both you and your loved ones, and you want to make sure that they understand ahead of time what your instructions are in regard to this. Your agent will be bound by the directions you set out in this section. The agent cannot override them.
Your Later Protest Will Be Honored
As noted in the Section “Protesting Care”, if, after being found to be incapable of making informed decisions about your care, you protest the withholding or withdrawal of life-prolonging procedures when you have a terminal condition, your protest will be honored and the instructions in our advance directive will not be carried out over your protest. (See Section 54.1-2986.2)