Advance directives are written, legal instructions regarding medical care preferences if one is unable to make the decisions for themselves. Advance directives guide choices for doctors and caregivers if one is terminally ill, seriously injured, in a coma, in the late stages of dementia, or near the end of life. The most common advance directives are the living will and the medical power of attorney.
A Living Will
A living will be a legal document used upon death when one becomes terminally ill, or permanently unconscious. This advance directive explains what medical treatment the person would want or would not want to receive including dialysis, tube feeding, and life support. A living will detail preferences such as pain management and organ donation.
Medical Power of Attorney
A medical power of attorney is a legal document naming an individual as a health care proxy to make a health care decision if you are unable to speak for yourself. A medical power of attorney is only granted once a physician deems one unable to make decisions for themselves.
Importance of Advance Directives
Advanced directives are important for all adults. An unexpected situation can happen at any time. Planning allows you to get the medical care you prefer, avoid unnecessary suffering, and relieve caregivers of decision-making burdens during moments of crisis or grief. This can help reduce confusion or disagreement about the choices you would want to make on your behalf.
Depending on location, the person chosen to make decisions on your behalf may be called a
- Health care agent
- Health care proxy
- Health care surrogate
- Health care representative
- Health care attorney-in-fact
- Patient advocate
Personal doctors and other healthcare providers are not able to serve as healthcare agents/proxies. It is important to choose someone you trust to be your healthcare agent. Choose an individual you feel understands your wishes and has your best interests at heart.
Healthcare decisions a health care agent can make:
- What drug treatments to pursue
- What doctors and facilities to visit
- What tests to run
- When and if you should undergo surgery
- Whether to disconnect life support
Medical choices to consider when planning advance directives:
- Cardiopulmonary resuscitation (CPR)
- Mechanical ventilation
- Tube feeding
- Antibiotics or antiviral medications
- Comfort care
- Organ and tissue donations
- Donating your body
Advance Directives General Information
- An advance directive is not needed to have do not resuscitate (DNR) and do not intubate (DNI) orders. To establish DNR or DNI orders, tell your doctor about your preferences. They should write them in your medical record.
- Advanced directives need to be in writing. Each state has different forms and requirements for creating legal documents. Depending on where you live, a form may need to be signed by a witness or notarized. A lawyer may be able to help with the process, but they are not required.
- You can modify an advance directive according to state at any time if one is still able to make decisions. A new document will have to be created and distributed to all involved including your healthcare providers and healthcare agent.