An advanced directive is a legal document that outlines your preferences for medical care if you become unable to make decisions for yourself. It ensures that your healthcare wishes are respected and provides clear guidance for your family and doctors during difficult times. Planning ahead with these documents offers peace of mind for both you and your loved ones.
What is an Advanced Directive?
An advanced directive is not a single form, but rather a set of documents that communicate your medical choices. These documents only go into effect if a physician determines that you lack the capacity to make or communicate your own decisions. This might happen due to a severe injury, a coma, or a late-stage illness like dementia.
By having an advanced directive in place, you take the guesswork out of your medical treatment. You can specify which treatments you want to receive and which you would prefer to avoid. This clarity helps prevent family conflicts and ensures that your values remain the priority in your care plan.
It is important to remember that advanced directives are for everyone, not just the elderly or the ill. Unexpected accidents can happen at any age, making it vital for every adult to have these documents prepared. They are easy to create and can be updated at any time as your preferences change.
The Two Main Components of an Advanced Directive
Most advanced directives consist of two primary parts: a living will and a durable power of attorney for healthcare. While they work together, they serve different purposes in your medical planning.
1. The Living Will
A living will is a written statement that details your preferences for end-of-life medical treatments. It specifies whether you want life-sustaining measures if you have a terminal illness or are in a permanent vegetative state. You can include instructions regarding the use of ventilators, feeding tubes, and cardiopulmonary resuscitation (CPR).
This document focuses on the “what” of your care. It allows you to define what a “good quality of life” means to you. You can be as specific or as general as you like, though more detail often helps doctors provide the exact care you desire.
2. Durable Power of Attorney for Healthcare
Also known as a healthcare proxy or medical power of attorney, this document names a specific person to make decisions for you. This person, called your healthcare agent or proxy, steps in only when you cannot speak for yourself. They are responsible for ensuring that doctors follow the instructions in your living will.
This document focuses on the “who” of your care. Choosing a proxy is a significant decision, as they may need to make tough choices in high-pressure situations. It is essential to choose someone who understands your values and is willing to advocate for your wishes.
Other Important Medical Documents
While the living will and power of attorney are the core components, other documents can supplement your advanced directive. These provide even more specific instructions for medical professionals and emergency responders.
Do Not Resuscitate (DNR) Order
A DNR is a medical order signed by a doctor that instructs healthcare providers not to perform CPR if your heart stops or you stop breathing. This is often used by individuals with chronic or terminal illnesses who do not wish to undergo invasive resuscitation efforts. Unlike a living will, a DNR is a direct medical order that emergency responders must follow.
Physician Orders for Life-Sustaining Treatment (POLST)
A POLST (or MOLST in some states) is a set of medical orders for patients with serious illnesses. It translates your advanced directive preferences into actionable medical orders. It covers a variety of treatments, such as intubation, antibiotic use, and feeding tubes, and is kept in your medical record for immediate access by staff.
How to Create Your Advanced Directive
Creating an advanced directive does not require a lawyer in most cases, though you may choose to consult one for complex situations. Following a few simple steps will help you complete the process accurately and legally.
Step 1: Reflect on Your Values
Think about what matters most to you regarding your health and quality of life. Consider your religious beliefs, your fears about certain treatments, and your definition of a meaningful life. Discussing these thoughts with family or a spiritual advisor can help clarify your choices.
Step 2: Choose Your Healthcare Proxy
Select someone you trust implicitly to act as your healthcare agent. This person should be someone who can remain calm under pressure and who is willing to follow your instructions even if they disagree with them. Always name an alternate proxy in case your primary choice is unavailable.
Step 3: Obtain State-Specific Forms
Advanced directive laws vary by state, so it is crucial to use the forms specific to where you live. You can often find these forms for free through your local hospital, state health department, or organizations like AARP. Many states also offer digital registries where you can upload your completed forms.
Step 4: Fill Out and Sign the Documents
Carefully complete the forms, ensuring that your instructions are clear and easy to understand. Most states require you to sign the documents in the presence of witnesses or a notary public. Be sure to check your state’s specific requirements to ensure the document is legally binding.
Common Medical Decisions to Address
When filling out your living will, you will encounter several specific medical interventions. Understanding what these are will help you make informed choices about your future care.
- Ventilation: A machine that breathes for you if you cannot breathe on your own. You can specify if you want this used temporarily or not at all.
- Nutrition and Hydration: This involves the use of IV fluids or feeding tubes to provide nutrients if you cannot eat or drink.
- Palliative Care: This is care focused on comfort and pain management rather than curing an illness. Most people choose to receive palliative care regardless of other choices.
- Organ Donation: You can specify whether you wish to donate your organs or tissues after death for transplant or research purposes.
Storing and Sharing Your Advanced Directive
An advanced directive is only useful if people can find it when it is needed. Keeping it locked in a safe deposit box is generally not recommended, as it may not be accessible in an emergency.
Keep the original document in a safe but accessible place in your home, such as a file cabinet or a desk drawer. Give a copy to your healthcare proxy and your alternate proxy. You should also provide a copy to your primary care physician to be included in your permanent medical record.
If you are admitted to a hospital or nursing home, bring a copy with you. Many people also keep a small card in their wallet stating that they have an advanced directive and listing the contact information for their healthcare proxy. This ensures that emergency responders know who to call.
When to Review and Update Your Directive
Your medical preferences may change as you age or as your health status evolves. It is a good idea to review your advanced directive every few years or whenever a major life event occurs. These events are often referred to as the “Five Ds”:
- Decade: Review your documents every ten years.
- Death: Review if a close family member or your named proxy passes away.
- Divorce: Update your documents if your proxy was a former spouse.
- Diagnosis: Review if you receive a diagnosis of a serious or chronic illness.
- Decline: Update your wishes if your physical or mental health significantly declines.
If you make changes, you must create a new document and follow the same signing and witnessing procedures as before. Make sure to destroy old copies and distribute the updated version to your doctor and proxy immediately.
Conclusion
Creating an advanced directive is a proactive way to take control of your future healthcare. It removes the burden of difficult decision-making from your family and ensures that your medical treatment aligns with your personal values. By taking the time to document your wishes today, you provide clarity and protection for yourself and those you love.
For more practical guidance on managing your health and legal documents, explore our other articles on estate planning, choosing insurance, and organizing important records at SearchAndHelp.com.