Advance Directives

What is an advance directive?

An advance directive is a document where you state your choices for important future health care decisions. You can also name someone to make those choices for you if you become unable to make decisions about your medical treatment. An advance directive allows you to be in control of the treatments you want. 

Advance directives allow people to make their wishes known when they become unable to make health care decisions. Under Nevada law, advance directives include two types of directives: the Living Will or “declaration” and the Durable Power of Attorney for Health Care. 

Living Wills 

A Living Will is a written declaration stating your wishes regarding the use of life-prolonging medical treatment. If you are well enough and competent, you tell your doctors what you do and do not want. In Nevada, the statutes say a Living Will may be used only if you are not able to make your own decisions, you have an incurable and irreversible condition and death is imminent. 

Nevada law gives you the option of completing two kinds of Living Wills or “declarations”. First is a declaration where you direct your attending physician to withhold or withdraw life-sustaining treatment. Second is a declaration appointing another person to make the decision for you about withholding life-sustaining treatment. When you complete a Power of Attorney for Health Care, it ultimately allows another person to make medical decisions for you. 

Durable Power of Attorney for Health Care 

What happens if you are incapacitated and your Living Will does not apply? With a Durable Power of Attorney for Health Care, you name the person you want to make medical decisions for you if you become incapacitated and are unable to make your own decisions. A Durable Power of Attorney for Health Care is only in effect once it is determined that the patient no longer has the capacity to make their own decisions. Furthermore, a Durable Power of Attorney expires upon the patient’s passing. 

Common Questions About Advance Directives 

Do I have to write an advance directive? 

No. It is entirely up to you. Under the Federal Patient Self-Determination Act, a facility must provide the same care regardless of whether a person has an advance directive. 

Where can I get these documents? 

Nevada law specifies by statute the suggested forms of a Living Will and a Durable Power of Attorney for Health Care. These statutory forms are usually available through your physician, other health care provider or attorney. For seniors in Las Vegas, you may also obtain these, at no charge, through the Southern Nevada Senior Law Program

Do I have to use the statutory forms? 

You may use or add the language of your own choosing, so long as the documents are in substantially the same form as provided in the statute. The Durable Power of Attorney for Health Care has several sections where the statute allows you to write in your own specific wishes. 

Can I change my mind? 

Yes. You may change or cancel these documents, at any time, in accordance with State law. Any change or cancellation should be written, signed, and dated in accordance with State law. 

Will I be treated for pain? 

Yes! Physicians and health care providers are required to provide treatment that is necessary for comfort or to alleviate pain. 

Please see your hospice social worker for a copy of the Nevada Advanced Directive and/or Five Wishes packet. 

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Dr. Cara Goo, D.O

Dr. Cara Goo, D.O. completed her Family Medicine residency at Guthrie Lourdes Hospital in Binghamton, NY where she first became interested in Palliative Medicine and its application in the clinic and the hospital. She is a graduate of Touro College of Osteopathic Medicine, and Pacific College of Health and Science, where she trained in Traditional Chinese Medicine, acupuncture, and herbs. In fellowship, she hopes to bridge osteopathic and integrative medicine with palliative care. 

Dr. Iryna Kobita, MD

Iryna Kobita recently completed her Internal Medicine Residency at The Valley Health System in Las Vegas and is pleased to continue her medical training in Hospice and Palliative Medicine. Prior to relocating to the United States, she practiced medicine in Ukraine, bringing valuable international clinical experience to her work. Iryna looks forward to contributing to the program, building strong professional relationships, and continuing to grow as a physician. Outside of medicine, she enjoys traveling, spending time outdoors, and being with family and friends.

Dr. Diana Lee, MD

Dr. Diana Lee graduated from Capital Medical University in Beijing, China, in 1991. Following graduation, she completed five years of pediatric residency training at Beijing Children's Hospital, one of the largest and most prestigious pediatric hospitals in China.

After relocating to the United States, she completed her second residency training program in Internal Medicine at Greater Baltimore Medical Center in 2004. She then worked as a hospitalist with Mercy Medical Group in Sacramento, California, for 10 years, before moving to Las Vegas to join Platinum Hospitalist Group, where she currently practices.

After earning her ABIM board certification in Hospice and Palliative Medicine in 2012, Dr. Lee focused her career on this specialty. In 2017, she established the first hospital-based inpatient palliative care consultation service in Las Vegas at St. Rose Dominican Siena Hospital. Under her leadership, this initiative expanded from a single-physician service into a multidisciplinary team of four palliative care physicians and 12 nurse practitioners, providing consultations across eight hospitals in Las Vegas. She has also served as the program director for the OPTI-West Hospice and Palliative Medicine Fellowship since 2021.

Dr. Lee is dedicated to advancing patient-centered palliative care through clinical excellence, program development, education, and collaboration. As the founder of one of the region's largest inpatient palliative care programs, she continues to expand access to specialty services and improve care for patients with serious illnesses throughout Southern Nevada.

Dr. Dan Miulli, DO, MS, FACOS

Graduate of Midwestern University-CCOM and completed Neurosurgical Residency Training at Allegheny General Hospitals receiving diploma from Philadelphia College of Osteopathic Medicine. Board certified in Neurological Surgery and Neurocritical Care. Practices Neurosurgery in Southern California. Is the Designated Institutional Official, Chief Academic Officer, and CEO of OPTI-West Educational Consortium and Sponsoring Institution.