Your Guide to Advance Directives
An advance directive is one potential part of advance care planning. This involves having conversations with your loved ones or trusted people about your medical care if you become seriously ill or unable to communicate your wishes.
What is an advance directive?
An advance directive is a legal document that outlines your wishes regarding future major medical decisions. These documents typically go into effect when you cannot communicate your wishes.
Typically, an advance directive addresses decisions related to end-of-life care. However, it can address any aspect of care. For example, many people use advance directives to focus on mental health treatments.
It is important to note that in the United States, advance directive laws may differ by state, and each state may only allow certain types.
Healthcare proxy
You can use an advance directive to name a healthcare proxy. This is a person who acts as a surrogate, agent, or representative for you if you cannot make decisions for yourself.
Your healthcare proxy will work closely with your healthcare team to ensure they follow your treatment and care preferences. Naming a healthcare proxy can be especially useful in unexpected situations, such as if you have a stroke or a car accident.
The requirements for healthcare proxies vary by state. In most states, the individual must be over 18 years old. Many people choose a family member. Other people may choose a lawyer, a trusted friend, or a neighbor. While each state sets its own requirements, the American Bar Association generally recommends not choosing any of the following:
your healthcare professional, their spouse, their employee, or the spouse of an employee
the owner or operator of your residential or healthcare facility
someone working for a government agency who is financially responsible for your care
any professional who is responsible for evaluating your ability to make decisions
your court-appointed conservator or guardian
someone who already serves has a healthcare proxy for 10 or more people
Types of advance directives
The two main types of advance directives are the living will and the durable power of attorney.
Living will
A living will is a legal document that states certain future healthcare decisions. It only becomes effective if you cannot make choices and decisions on your own.
It is called a 'living' will because it is in effect while you are still alive. It often involves decisions regarding end-of-life care.
A living will can describe under what circumstances attempts to prolong life should be used or stopped. This applies to treatments like dialysis, feeding tubes, and life support. Healthcare professionals can only use your living will to guide medical decisions after two doctors confirm you cannot make decisions for yourself.
You can end or take back your living will at any time. However, a living will must comply with state law to be legally valid, which may vary.
»Learn more: Living wills.
Durable power of attorney
A durable power of attorney is a legal document that allows you to appoint a proxy to make medical, legal, or financial decisions on your behalf.
A durable power of attorney typically becomes effective when you can no longer make independent decisions.
It is important to note that while some states recognize a durable power of attorney as active as soon as it is signed, your proxy cannot use it to make medical decisions until your doctor certifies that you cannot make them yourself.
»Learn more: Healthcare power of attorney.
Other types
There are two other types of advance directives:
Do Not Resuscitate Order (DNR): This is a written document that is typically signed by your healthcare professional that states whether you want them to resuscitate you if you stop breathing or your heart stops. In most states, this is the only advance directive order Emergency Medical Services (EMS) have to consider. A DNR allows you to choose which procedures to accept or decline.
Physician's Orders for Life-Sustaining Treatment (POLST): A POLST is a newer type of advance directive. It is an agreement between a doctor and you regarding a specific condition. The POLST documents the condition, summarizes your wishes regarding treatment, and records your wishes as medical orders.
Who needs an advance directive?
Anyone can consider setting up an advance directive. People of any age can experience a medical crisis that could leave them unable to communicate their medical wishes.
However, advance directives may be more important for older people to consider. Individuals with a recent diagnosis of dementia may find it particularly important to put this document in place to protect their future needs and wishes. It allows them to participate directly in the decision making about their care.
What if you don't have an advance directive?
If you don't have an advance directive and you become unable to make your own decisions, the laws in the state where you live determine who will make medical decisions on your behalf. Generally, this may be your spouse, adult children, or your parents if they are available.
If you are unmarried and have not officially named your partner as your proxy, they may be unable to participate in the decision making.
If you do not have any family members, the state may appoint a close friend or a doctor to act in your best interest.
To find the laws in your state, contact your state legal aid office or state bar association.
Tips for getting started
To get started with creating an advance directive, consider the following:
Reflect: Take the time to consider your values and wishes. This can help you decide what matters most to you regarding end-of-life care and guide you in your decisions.
Talk: Speak with your primary care doctor about advance directives. This can help you learn more about your current health and what decisions may come up in the future.
Choose: Pick someone you trust as your healthcare proxy. Once you have decided, speak with this person about your values and wishes.
Complete: Fill out any necessary forms to create the type of advance directive you desire.
Share: Show your completed advance directives to your healthcare proxy, loved one, and doctors. Some states may even have a registry where you can store your advance directive for easy access by healthcare professionals or your proxy.
Be sure to continue discussing your wishes and update your advance directive each year or after siignificant life changes.
Did you know?
Medicare covers Advance care planning as part of your annual wellness visit. Medicare may also cover this service as part of your medical treatment.
If you receive this service from your doctor during your annual wellness visit, there is no cost to you. If you receive it during any other type of appointment or treatment, the Medicare Part B deductible and 20% coinsurance apply.
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