It is not something we want or like to have to think about but in order for our last wishes regarding our medical care to be carried out the law requires that we have an Advanced Directive prepared and it must meet certain legal requirements. Preparing an Advanced Directive is something that is to be thought through carefully and discussed with your physician and your family so everyone understands what your last wishes are when it comes to health care. Advanced Directives are not just for the elderly. All people who desire to direct their medical care in the future should complete an Advance Directive.

What is an Advanced Directive?

Advanced Directives address the principles of your right to die and death with dignity. With an Advanced Directive you can express how much or how little you want done for you with regard to medical care when you are no longer able to make these decisions. Advanced Directives are a way of making your voice heard when you can no longer communicate. Common situations in which a person may be temporarily or permanently unable or incapable of making complex decisions regarding their medical care or end of life decisions include the following: coma (from any cause); stroke (if it results in coma or cognitive deterioration); moderate or severe dementia (Alzheimer’s or other types); persistent vegetative state; severe illness requiring placement on breathing machine and inability to communicate; severe medical conditions such as advanced liver failure or kidney failure; traumatic brain injury resulting in the inability to make complex decisions.

There are two types of Advanced Directives

  1. Living Will
  2. Durable Medical Power of Attorney for Medical Care (also referred to as a health care surrogate or health care proxy)

What is a Living Will?

A Living Will is a written statement that tells health care professionals what type of life-prolonging treatments or procedures to perform if someone has a terminal condition or is in a persistent vegetative state. A living will only deal with and address issues regarding your medical care while you are still living. There are many issues to address when it comes to preparing a Living Will. Some of these issues include the following:

  • The use of dialysis and breathing machines
  • If you want to be resuscitated if breathing or heartbeat stops
  • Tube feeding
  • Organ or tissue donation

What is a Durable Medical Power of Attorney?

The second part of an Advanced Directive is a Durable Medical Power of Attorney for Health Care, also known as a health care surrogate. This legal document allows you to select any person to make medical decisions for you if you should become temporarily or even permanently unable to make those decisions for yourself. This person is also sometimes referred to as your attorney-in-fact or health care proxy. It is not required that this person be an attorney. Most people choose a family member, a relative, or a close friend as their surrogate decision maker. It is important that the designated power of attorney knows and understands your wishes and preferences and can easily and promptly provide a written copy of the necessary documents.

More about Advanced Directives

It is important to clarify that an Advance Directive does not mean “do not treat”. This is a common misperception and is not correct. Proper execution of an Advance Directive is a delicate task. A person should discuss their wishes with their loved ones and consider their inner values and beliefs. Religious and spiritual beliefs also play an important role in writing an Advanced Directive.

Since it is also impossible to think about all the possible medical and social scenarios that may happen in the future during the course of a disease and an individual’s lifetime, the individual can change their mind contrary to their Advanced Directive while they are still capable of making his or her own decisions. Living wills can be modified to reflect any such changes if they occur. If you already have completed your Advanced Directives now would be a good time to review them to be sure you are still satisfied with your decisions and the person you identify in your health care proxy is still willing and able to carry out your plans. Find out how to cancel or update them in your state if they no longer reflect your wishes.

Since Advanced Directives are legal documents it is important to adhere to your individual state’s requirements regarding preparation of Advanced Directives. Some states may allow you to combine your Advanced Directives in one document.

For more information, contact your health care provider, an attorney, your local area Agency on Aging,  or your state health department.


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