Advance Care Planning: Advance Directives

Having an advance directive means that you have written down your wishes about medical treatment. This information can help others know what to do if you can no longer speak for yourself.

A living will and a durable power of attorney for health care are the two main types of advance directives.

What do advance directives cover?

An advance directive may be important if you cannot communicate. This could happen if you are badly hurt or have a serious illness.

Without a living will and a health care agent, decisions about your care may be made by a doctor who does not know you, or even by a judge.

What is a living will?

A living will puts in writing how you want to be treated at the end of your life. For example, it tells when you would or would not want your doctor to use life-support measures.

Laws vary from state to state about when a person may refuse life support through a living will.

Although you can write your own living will, legal advice may be useful. This is especially true in states where living wills are not recognized or where the laws governing them are not clear.

What is a durable power of attorney for health care?

A durable power of attorney for health care is a legal form in which you choose someone to make medical decisions for you when you cannot make them for yourself. This person is usually called your health care agent or health care proxy.

Your health care agent can make medical decisions on your behalf at the end of life. Your agent also can make decisions any other time you cannot speak for yourself, such as if you are badly hurt in an accident.

To make these decisions, your health care agent can use the information in your living will, statements you have made in the past, and what your agent knows about you personally. Your agent can consent to surgery. Your agent can refuse to have you placed on life-support machines. Your agent can request that you be taken off life support.

When should you prepare an advance directive?

It is never too soon to prepare an advance directive. This document would apply if you were badly hurt in an accident. Having an advance directive means your loved ones will never have to guess what your decisions would be.

Some people are not comfortable with having an advance directive, especially a living will.

This may be because of religious or spiritual reasons or other beliefs. If you choose not to have a living will, your family and your doctor should respect your decision.

What if you change your mind?

You can change or cancel your advance directive at any time by completing a new one, destroying your existing forms, or simply telling your caregivers.

How do you write an advance directive?

There are four important steps:

  • Get the right forms for your state, or use a universal form that has been approved by many states. In most cases, doctors will respect your wishes even if you have a form from a different state.
  • Choose someone to be your health care agent.
  • Complete the forms and have them notarized or witnessed as your state requires. Your state may offer an online registry. This is a place you can store your advance directive so authorized health care providers can find it right away.
  • Make sure that your doctor, your family, and your health care agent have copies. If you are using an electronic form, be sure your doctor, family members, and health care agent have instructions about how to access it on the Internet.

Where can you find out more?

For more information, including forms for your state, see the CaringInfo website (www.caringinfo.org/planning/advance-directives).