Advance Directives

Legal Documents To Assure Future Healthcare Choices

Living wills and other advance directives describe your preferences regarding treatment if you're faced with a serious accident or illness. These legal documents speak for you when you're not able to speak for yourself — for instance, if you're in a coma.

Living wills and other advance directives aren't just for older adults. Unexpected end-of-life situations can happen at any age, so it's important for all adults to have advance directives.

Advance directives: More than just living wills

Advance directives are written instructions regarding your medical care preferences. Your family and doctors will consult your advance directives if you're unable to make your own healthcare decisions.

Having written instructions can help reduce confusion or disagreement. Anyone age 18 or older may prepare advance directives.  

Advance directives include:  

Living will. This written, legal document spells out the types of medical treatments and life-sustaining measures you do and don't want, such as mechanical breathing (respiration and ventilation), tube feeding or resuscitation. In some states, living wills may be called healthcare declarations or healthcare directives.  

Medical power of attorney (POA). The medical POA is a legal document that designates an individual — referred to as your healthcare agent or proxy — to make medical decisions for you in the event that you're unable to do so. A medical POA is sometimes called a durable power of attorney for healthcare. However, it is different from a power of attorney authorizing someone to make financial transactions for you.  

Do not resuscitate (DNR) order. This is a request to not have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. Advance directives do not have to include a DNR order, and you don't have to have an advance directive to have a DNR order. Your doctor can put a DNR order in your medical chart.

How to plan for end-of-life issues

Injury, illness and death aren't easy subjects to talk about, but by planning ahead you can ensure that you receive the type of medical care you want, to take the burden off your family of trying to guess at what you'd want done. Start by having a conversation with your loved ones. Let them know you're creating advance directives and explain your feelings about medical care and what you'd want done in specific instances.

If you want to encourage parents or other family members to create advance directives, explain that it's important for you and the family to know how they would want to be treated. It's generally best to approach the subject in a matter-of-fact and reassuring manner.  

Keep in mind that a living will cannot cover every possible situation. Therefore, you may also want a medical POA to designate someone to be your healthcare agent. This person will be guided by your living will but has the authority to interpret your wishes in situations that aren't described in your living will. A medical POA may also be a good idea if your family is opposed to some of your wishes or is divided about them.  

Choosing a healthcare agent

Choosing a person to act as your healthcare agent is possibly the most important part of your planning. You need to trust that this person has your interests at heart, understands your wishes and will act accordingly. He or she should also be mature and levelheaded, and comfortable with candid conversations. Don't pick someone out of feelings of guilt or obligation.  

Your healthcare agent doesn't necessarily have to be a family member. You may want your healthcare decision maker to be different from the person you choose to handle your financial matters. It may be helpful, but it's not necessary if the person lives in the same city or state as you do.  

What treatments would you want?  

In determining your wishes, think about your values, such as the importance to you of being independent and self-sufficient, and what you feel would make your life not worth living. Would you want treatment to extend life in any situation? Would you want treatment only if a cure is possible? Would you want palliative care to ease pain and discomfort if you were terminally ill?  

Although you can't predict what medical situations will arise, be sure to discuss the following treatments. It may help to talk with your doctor about these, especially if you have questions.  

Resuscitation. Restarts the heart when it has stopped beating (cardiac death). Determine if and when you would want to be resuscitated by cardiopulmonary resuscitation (CPR) or by a device that delivers an electric shock to stimulate the heart.   Mechanical ventilation. Takes over your breathing if you're unable to do so. Consider if, when and for how long you would want to be placed on a mechanical ventilator.  

Nutritional and hydration assistance. Supplies the body with nutrients and fluids intravenously or via a tube in the stomach. Decide if, when and for how long you would want to be fed in this manner.  

Dialysis. Removes waste from your blood and manages fluid levels if your kidneys no longer function. Determine if, when and for how long you would want to receive this treatment.  

Organ donation  

You can also specify in your advance directives any wishes you have about donating your organs, eyes and tissues for transplantation or your body for scientific study. If you wish to donate your body for scientific study, contact the medical school closest to your home for details.  

Forms are state specific

Your advance directives should be in writing. Each state has its own laws regarding advance directives. Although it isn't required, you may want to consult an attorney about this process.

Your instinct might be to put your advance directives somewhere safe, like a safe-deposit box, but that will only make it difficult for your loved ones to find the forms when they need them.  

Review your advance directives from time to time  

As your health changes or your perspective on life changes, you might reconsider some of your advance directives. Read over your advance directives from time to time to see if you want to revise any of the instructions. You can change your mind about your advance directives at any time.  

To revise your advance directives, you follow the same steps you used to create them. Get new advance directive forms to fill out. Discuss your changes with your friends, family and doctor. Then distribute copies of the new advance directives and ask everyone to destroy the earlier version.  

If there isn't time to redo the paperwork, you can always cancel your advance directive by telling your doctor and your family. Remember, a living will or medical POA only goes into effect if you are unable to make medical decisions for yourself, as determined by your doctors.    

To make these difficult issues easier to understand, we have presented the information in the form of questions and answers. Because this is an important matter, we urge you to discuss your decisions with your spouse, family, close friends, personal advisor, your doctor and  your attorney.