West Virginia E-Directive Registry and Advance Care Planning

What the E-Directive Registry Is

West Virginia operates a statewide electronic registry where residents can file their advance healthcare directives — medical powers of attorney, living wills, and the combined medical POA/living will document. The registry is maintained by the West Virginia Center for End-of-Life Care and is accessible to healthcare providers across the state.

The purpose is practical: when your parent arrives at a West Virginia emergency room unconscious or unable to communicate, the treating physician can query the registry to find out whether an advance directive exists, who the appointed healthcare representative is, and what the parent's documented wishes are regarding life-prolonging treatment. Without the registry, the ER team has no way to know these documents exist unless someone brings a physical copy.

How to Register

Registration is free. The process involves submitting a copy of the executed advance directive — either the standalone medical power of attorney, the standalone living will, or the combined document — to the West Virginia Center for End-of-Life Care. Submissions can be made by fax or mail.

The directive must already be properly executed before registration: signed by the principal, witnessed by two qualified adults, and notarized per W. Va. Code § 16-30-4. The registry stores the document; it doesn't validate or certify it. If the execution was defective (wrong witnesses, missing notarization), the registry filing doesn't cure the defect.

After submission, the center provides confirmation and a wallet card. Keep those records accessible in an emergency and give the relevant information to the parent's healthcare providers.

What Registration Doesn't Do

The e-Directive Registry stores advance directives and can also accept durable powers of attorney. It is not a substitute for recording a financial POA when a real-estate transaction requires recording in the county clerk's office where the property is located.

Registration does not replace sharing the directive with providers. The Center says providers can access registered documents through the West Virginia Health Information Network, but you should still keep a physical copy with the parent's important papers and give copies to every healthcare provider involved in their care.

The Advance Care Planning Conversation

The registry is the last step in a process that starts with a conversation most families avoid until it's too late. Advance care planning means documenting your parent's preferences for medical treatment before a crisis forces decisions in a hospital hallway.

The key decisions to address:

Life-prolonging treatment preferences. The combined medical POA and living will form asks the principal to state their wishes regarding CPR, mechanical ventilation (breathing machines), artificial nutrition and hydration (feeding tubes), and dialysis. These aren't abstract questions — they determine what happens when a doctor asks "do you want us to do everything possible?" and the patient can't answer.

Hospice and comfort care. If your parent's condition becomes terminal, do they want aggressive treatment to extend life as long as possible, or do they prefer comfort-focused care (hospice) that manages pain and symptoms without attempting to cure the underlying condition? The advance directive can specify this preference, and the appointed healthcare representative should understand the parent's wishes clearly enough to make this call.

Organ and tissue donation. While not part of the medical POA itself, the advance care planning conversation should cover whether the parent wants to be an organ donor. West Virginia's donor registry is separate from the e-Directive Registry.

Preferred care location. Does the parent want to remain at home as long as possible, even if that means declining certain treatments that require hospitalization? Or would they prefer the maximum medical intervention available in a hospital setting? This preference shapes the healthcare representative's decisions about transfers and admissions.

Who Can Serve as Healthcare Representative

Under the West Virginia Health Care Decisions Act, the appointed healthcare representative cannot be the parent's treating healthcare provider, an employee of that provider, or an operator or employee of the healthcare facility serving the parent — unless they're related to the parent by blood, marriage, or adoption.

In practical terms, this means you can serve as your parent's healthcare representative even if you work at the hospital where they receive care, as long as you're a family member. But a family friend who works at the same facility typically cannot serve.

The directive should name at least one successor representative in case the primary is unavailable. If no representative is designated and the parent loses capacity, healthcare decisions fall to the statutory surrogate hierarchy — spouse, adult children, parents, adult siblings, adult grandchildren, close friends, and other persons or entities listed in W. Va. Code § 16-30-8 — which can create family conflict when multiple children disagree.

Acting Under the Medical POA

The healthcare representative's authority activates only when the parent's attending physician determines they lack the capacity to make informed healthcare decisions. If the incapacity results from a psychiatric illness, intellectual disability, or addiction, a second clinical opinion from a qualified mental health professional is required under W. Va. Code § 16-30-24.

If the parent regains capacity, the representative's authority is suspended until a physician determines they've lost capacity again. The parent always retains the right to revoke the directive entirely if they have capacity: they may destroy it, sign and deliver a written revocation, or express the intent to revoke in the presence of a witness at least 18 years old who signs and dates a confirming writing, followed by communication to the attending physician.

The West Virginia Power of Attorney & Guardianship Kit includes the combined medical POA and living will with execution instructions, witness qualification rules, and registry filing guidance — so your parent's healthcare preferences are documented, properly executed, and accessible to the providers who need them.

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