What Is An Advance Directive?

An advance directive, also called an advance care plan, is a legal document that outlines your healthcare preferences in the event that you become unable to make decisions for yourself.

This document is completed ahead of time and can help ensure that your wishes are respected and followed, even if you’re unable to communicate them at the time.

If you haven’t already, you should create an advance directive right now – it is that important!

There are two common types of advance directives: a living will and a durable power of attorney for healthcare.

A living will specifies the types of medical treatments you want or don’t want in certain situations, such as if you’re in a coma or have a terminal illness.

A durable power of attorney for healthcare designates someone to make medical decisions for you if you’re unable to do so yourself.

Advance care planning is an important part of preparing for the end-of-life.

By creating an advance directive, you can ensure that your loved ones and health care provider know your wishes for medical treatment. This can help alleviate any confusion or disagreements about your care.

It’s important to remember that an advance directive isn’t only for the elderly or those with terminal illnesses.

Anyone can benefit from having one, as unexpected accidents or illnesses can happen at any age.

By taking the time to create an advance directive, you can have peace of mind knowing that your wishes will be respected.

Key Takeaways

• Advance directives are legal documents that outline an individual’s preferences for medical treatment in the event they become unable to make decisions for themselves.
• Advance care planning is critical for ensuring that an individual’s wishes are respected and followed.
• Living wills and durable power of attorney for healthcare are the two main types of advance directives, and they serve different but complementary purposes.
• It is important to appoint a healthcare proxy who will advocate for an individual’s wishes and ensure that their living will is followed.

The 2 Common Types of Advance Directives

Living Wills

Living wills are an important tool for individuals to communicate their end-of-life wishes in a legally binding document.

This type of advance directive is a legal document that outlines an individual’s preferences for their health care decisions when they are no longer able to make decisions for themselves.

Here are some important points to keep in mind when it comes to living wills

• A living will can specify what type of life-sustaining treatment an individual would like to receive or not receive if they are unable to communicate their wishes. This can also include withholding of care, as in a “do not resuscitate” order, also called a “DNR.”
• It’s important to choose a health care agent or power of attorney for health care who will make decisions in accordance with the individual’s wishes outlined in the living will.

Durable Power of Attorney for Healthcare (health care power of attorney)

You should consider appointing a durable power of attorney for healthcare (also called healthcare proxy or healthcare declaration in some states) to ensure your medical decisions are made by someone you trust if you become unable to make them yourself.

This is a legal document that allows you to appoint a health care proxy, someone who can make health care decisions on your behalf.

This person should be someone who understands your wishes and values, and who you trust to communicate with health care professionals.

A durable power of attorney for healthcare can also include orders for life-sustaining treatment, outlining what medical care you want or don’t want.

This document is typically included in your medical record, so healthcare professionals can refer to it and ensure that your wishes are being respected.

Physician Orders for Life-Sustaining Treatment (POLST)

POLST forms are a crucial tool for ensuring that a patient’s end-of-life care wishes are respected.

This pertains directly to people who are in hospice care. If you want to learn more about the difference between palliative and hospice care, please read my article here.

Final-stage dementia patients should also have a POLST form completed and available for emergency responders.

To identify the signs that death is near for dementia patients, I suggest reading my linked article.

The Physician Orders for Life-Sustaining Treatment (POLST) is a specific type of advance directive that’s a legal document outlining a patient’s medical care preferences.

It’s meant to guide medical decisions in emergency situations when the patient can’t communicate their wishes.

This could happen in the person’s home, or a health care facility – the location does not matter.

The form’s filled out by a health care provider in consultation with the patient and includes specific instructions regarding the use of life-sustaining treatments such as CPR, intubation, artificial nutrition, and hydration.

It also allows patients to express their wishes regarding comfort measures and pain management.

Since these are legally-recognized orders, a discussion MUST occur between the patient and their physician and the doctor must place their signature on the form.

This form should be placed in a prominent place in the home, such as on the refrigerator, where emergency first responders know to look.

A POLST form is different from other types of advance directives because it’s intended for patients with serious illnesses or conditions that may require immediate medical attention.

It is usually reserved for patients who are older, frail, or who have chronic or advanced illnesses. It is usually brightly colored.

In my home state of New York, the form is called the MOLST (Medical Orders For Life-Sustaining Treatment) and it is colored bright pink.

It’s important to note that a POLST form doesn’t replace other types of advance directives such as a health care proxy or living will. It’s a supplement that provides specific instructions for end-of-life care.

The video below from a licensed medical doctor provides a nice overview of advance care planning:

Advance directive examples

Each state in the US has its own version of advance directive forms. The examples below are from New York State:

Living Will Example

Durable power of attorney example

 

Potential issues with advance directives

As you consider the effectiveness of advance directives, it’s important to acknowledge their limitations.

While they provide guidance for medical decision-making, they may not cover every possible scenario or change in your condition.

Additionally, advance directives should not be seen as a replacement for clear and ongoing communication with your healthcare team and loved ones about your values, goals, and preferences.

Limitations

Although advance directives can provide guidance for end-of-life care, it’s important to note that they have limitations and may not cover all possible scenarios.

Here are some limitations to keep in mind when creating an advance directive:

• Advance directives are legal documents that outline your medical decisions, but they can’t cover all possible situations. For example, you may not be able to anticipate every medical condition or treatment option that may arise in the future.
• You may have changed your mind about your treatment but may have forgotten to tell your loved ones and your doctor.
• The advance directive has vague language that could be misconstrued, or the language is too specific and does not account for future health status changes.
• It’s also important to note that an advance directive may not be followed if your healthcare team believes it’s not in your best interest. In such cases, your healthcare proxy may need to make difficult decisions on your behalf based on your wishes and values.
• Another limitation of advance directives is that they only come into effect when you’re unable to make decisions for yourself. If you’re able to communicate your medical decisions, your healthcare team will follow your instructions directly rather than relying on your advance directive.

Considering these limitations, it’s important to discuss your end-of-life care wishes with your loved ones and healthcare team to ensure that your medical care aligns with your values and goals.

Importance of Communication

To truly ensure that your end-of-life care aligns with your values and goals, it’s crucial that you communicate your wishes with your loved ones and health care team.

While an advance directive is a legal document that can help guide decisions on your behalf in case you’re unable to make medical decisions for yourself, it’s not a substitute for clear, specific communication.

Effective communication can help your loved ones and health care team understand your values and preferences, and can help ensure that your wishes are followed.

It’s important to have these conversations early before a medical crisis arises so that everyone is on the same page when it comes to your health care.

You can also update your advance directive as your healthcare wishes change over time.

Who Needs an Advance Directive?

It’s important to note that an advance directive isn’t just for elderly or terminally ill individuals, but for anyone who wants to have control over their patient care. Here are four reasons why you may need an advance directive:

1. Accidents can happen at any age: You never know when an unexpected event may occur that leaves you unable to make medical decisions. By having an advance directive in place, you can ensure that your wishes for medical care are followed.
2. Peace of mind for loved ones: By having an advance directive, you can relieve the burden of decision-making from your loved ones. They’ll know exactly what your wishes are and can focus on supporting you instead of trying to guess what you would want.
3. Avoiding unwanted medical treatment: If you have specific beliefs or values that you don’t want to be compromised, an advance directive can ensure that your medical decisions reflect those beliefs. This can include refusing certain medical treatments or procedures.
4. Required by some healthcare facilities: Some healthcare facilities may require patients to have an advance directive on file before receiving medical care. By having one in place, you can ensure that you’re able to receive the medical care you need without delay.

What happens when you don’t have an advance directive?

Without an advance directive, your family and healthcare providers will have to make those decisions for you.

This can create a lot of stress and uncertainty for your loved ones. They may not know what you want, and their decisions may not align with your wishes.

Additionally, if you’re in a healthcare facility, such as a hospital or nursing home, they may have their own protocols for end-of-life care that may not align with your beliefs or values.

How to start with advance care planning?

Step 1: Think carefully about your wishes and values – what is most important to you about your future health and medical treatment?

Step 2: Schedule time to talk to your doctor and your loved ones about advance care planning.

Step 3: Choose the person you trust to make medical decisions for you when you can’t.

Step 4: Complete your advance directive forms (Living Will AND Durable Power of Attorney).

Step 5: Share your completed forms with your doctor, loved ones, and health care proxy.

Step 6: Continue the conversation! Revisit your choices every 6 months or so and update your forms accordingly. Your wishes or health may change!

Step 7: Keep the latest version! Take note of the dates of updated forms.

How to find advance directive forms?

Your healthcare provider may have advance directive forms available for you to complete, or they may be able to provide guidance on how to locate them.

Additionally, many states have specific forms and requirements for advance directives, so it’s important to ensure that you’re using the appropriate form for your location.

Online resources such as state health department websites or legal document providers can also be useful in locating advance directive forms.

Here are some resources:

• AARP.
• National Hospice and Palliative Care Organization.
• Veterans: Contact your local VA office.
• American Bar Association.

Frequently Asked Questions

What are the legal requirements for an advance directive to be valid?

To be valid, an advance directive must be in writing, signed by the person creating it, and witnessed by two individuals. It must also be voluntarily created and the person must be of sound mind at the time.

Can an advance directive be modified or revoked once it has been created?

Yes, an advance directive can be modified or revoked at any time as long as you are mentally capable of making decisions. Simply inform your healthcare provider and make the necessary changes to the document.

How do family members and healthcare providers determine when to activate an advance directive?

To activate an advance directive, family members and healthcare providers should consult with the patient’s healthcare team to determine if the patient’s condition meets the criteria outlined in the directive.

Follow the patient’s wishes as specified in the document.

What role do religious beliefs play in making decisions outlined in an advance directive?

Consider your religious beliefs when making decisions outlined in an advance directive.

Your faith may influence your choices regarding end-of-life care, resuscitation, and organ donation.

Discuss your wishes with your family and healthcare providers.

Are there any limitations to what can be included in an advance directive, such as specific medical treatments or procedures?

You can specify any medical treatment or procedure in an advance directive, as long as it’s legal and medically available.

However, it’s important to discuss your wishes with your doctor and loved ones to ensure they are carried out properly.

Conclusion

Remember, advance directives are not only for the elderly or those with chronic illnesses but for anyone who wants to have control over their medical treatment in case they become unable to communicate their wishes.

Not having an advance directive can result in unwanted medical treatments or decisions being made on your behalf.

It’s important to start the conversation about advance care planning with your loved ones and healthcare professionals.

You can also find advance directive forms online or through your healthcare provider. Take action now and ensure that your wishes for medical treatment are respected and followed.