Advance Directives for Health Care: Removing Uncertainty When You Cannot Speak For Yourself

It is not something any of us likes to think about, but there could come a time when we face a life-threatening illness or injury that leaves us incapable of communicating our wishes about the medical care we receive. If you are unable to talk in such a situation, your loved ones would be placed in a very difficult, stressful position, not knowing what to do, not knowing what you would want. That is, unless you had taken the time to create and sign advance directives for health care.

Advance directives are legal documents that describe in writing your preferences for life-saving and sustaining medical care. They speak for you when you cannot –for instance, if you are in a coma. Advance directives come in two primary forms and can be prepared by anyone age 18 and over, serving to guide family members and doctors when you cannot make your own health care decisions. You do not have to have a lawyer to complete advance directives, but you do need to sign them in front of required witnesses.

What are the differences in advance directives?

• A living will is a legal document that enables you to declare your wishes to receive or to have withheld life support procedures when permanently unconscious or terminally ill and unable to make informed decisions. Living wills also are referred to, in some states, as a health care declaration or health care directive.
• A durable power of attorney (POA) for health care is a legal document in which you designate a trusted individual—your “agent”—to make medical decisions for you when you are unable. Do not confuse this with a financial power of attorney, which authorizes someone to make financial decisions for you when you are incapacitated. The POA can grant broad or specific powers to the agent. In your POA you can specify the treatments you would or would not want to receive.
• A do not resuscitate (DNR) order sometimes supplements advance health care directives. Placed in a patient’s medical chart, a DNR is usually used by people who are already critically ill and feel strongly against use of life-prolonging measures.

Access To All States’ Advance Directive Forms

All states have advance directive laws, but they vary. It is important to complete and sign advance directive forms designed for your state.

Caring Connections, a program of the National Hospice and Palliative Care Organization (NHPCO), offers online access to advance directive information and forms from all 50 states.

Caring Connections advises:

• Not all states honor other states’ advance directives, so it is a good idea to complete advance directives for all states where you spend a significant amount of time.
• Advance directives remain in effect until you change them.
• Review your advance directives periodically to make sure they still reflect your wishes.