“For reasons unknown-maybe because her mother was a former nurse-care at the end of life was an issue Jane had talked about with her parents for a long time.  “It just came up really naturally”, recalls Jane, “especially as they had friends who were aging or ill, and my parents must have visited about it between them.  They were very unified about what they wanted.”  After Jane’s mother was hospitalized with a brain hemorrhage, Jane realized that not only had her parents “talked the talk,” but that the right paperwork had been done, too.  Says Jane:  “We had the legal papers-the advance directives-and I knew where they were.”  Jane’s mother had also spoken with her physician about the kind of care she wanted at the end of life.  “Nobody has ever been clearer with me about her wishes than your mother,” the doctor told Jane.”  For Jane, knowing her mother’s wishes about end-of-life care, truly felt like a gift!

If you do not have an advance directive in place and you become seriously ill or injured, your doctors, hospital staff and loved ones will do the best they can.  However, without clear direction from you, your loved ones my have to guess what you would want.  If there is any uncertainty about your wishes, care could be delivered that may not be consistent with your wishes.  If you want people to know - and follow - your wishes, you should talk with them about your preference and have a written and signed health care directive/advance directive in place.



What is a Health Care Directive?

A health care directive is a written declaration that allows you to:

1. Give instructions about any aspect of your health care.

2. Choose a person to make health care decisions for you.

3. Give instructions about specific medical treatments you do or do not want.

4. Give other instructions, including where you wish to die.

5. Make an anatomical gift.


Why should I complete a Health Care Directive?

There may come a time when, due to your mental or physical condition, you may be unable to make your own health care decisions.  Then your health care providers will look to any prior written advance directives or to family members to make decisions on your behalf.  A doctor must make a determination that you are unable to make your own health care decisions.


Who can make a health care directive?

Any competent person 18 years of age or older.


Does a health care directive need to be in writing?

Yes.  To be legally sufficient in ND, a health care directive must be in writing.


Can I revoke my health care directive?

Yes. As long as you remain competent you can revoke your health care directive.


After I have signed a health care directive, what should I do with it?

It is a good idea to talk about your health care directive with your doctor and other health care providers, and your family, since your doctor will probably consult them in the event you are unable to make your own health care decisions.  Copies should be given to your agent, doctor, any other health care providers, and members of your family.


What is an agent?

An agent is an adult that you give the authority to make health care decisions for you, as provided in your health care directive.


Who should I appoint as my agent?

Your agent should be someone you know and trust, who knows how you feel about medical treatment, who understands your beliefs and values, and who is willing to carry out your wishes.  The appointment of an alternate agent is not required, but it is a good safeguard if something should happen to your original agent.


What are my agent’s responsibilities in carrying out my wishes?

Your agent is required to follow your wishes as contained in your health care directive.  If your wishes are unknown, your agent is required to make health care decisions for you based on what he or she feels is in your best interest.


When does a health care directive become effective?

A health care directive is effective when all of the following occur:

1. You have executed a health care directive;

2. Your agent, if any, has accepted the position as agent in writing; and

3. Your doctor has certified, in writing, that you lack the capacity to make health care decisions.  You lack the capacity to make health care decisions when you do not have the ability to understand and appreciate the nature and consequences of a health care decision, including the significant benefits and harms of proposed health care, or reasonable alternatives to that health care.


Can I still make my own health care decisions after I have signed a health care directive?

Yes.  You will be able to make your own health care decisions as long as you are capable of doing so.  Your agent’s authority starts only when your doctor certifies in writing that you do not have the capacity to make health care decisions.


Where should I keep my health care directive?

The original signed copy should be given to your agent or you should keep it where it is immediately available to your agent and your alternate agent, your doctor, and any other health care provider.


Can my agent or alternate agent withdraw?

Yes.  An agent or alternate agent may withdraw by giving you notice prior to the time you are determined to lack capacity to make health care decisions.  After such time, your agent or alternate agent may withdraw by giving notice to your doctor.


Do I need a lawyer to help me make a health care directive?

No.  A lawyer may be helpful and you might choose to discuss these matters with an attorney, but there is no legal requirement in North Dakota to do so. 


Whom should I talk to if I want more information or if I want to compete a health care directive?

1. You may talk to your attorney.

2. You may contact the social worker at Cavalier County Memorial Hospital.  Health Care Directives (Advance Directives) forms are available at the hospital. 

3. You can research information about health care directives at    

    www.nd.gov/humanservices.    Copies are available online.

4.You can contact ND Dept. of Human Services at 1-800-451-8693.