Advanced Directive for Healthcare

What is an advance directive?

Competent adults, after being informed of the techniques, risks and possible complications of proposed medical treatment, have the right to make their own decisions regarding acceptance or refusal. With today's medical technology, a person can be kept alive for an extended period of time. Some people do not desire any medical intervention to prolong their life, while others want every possible measure taken. If a patient is no longer able to make or express their own decisions, has not provided any written guidance, and has not assigned that right to an agent or alternate, others, including health care providers and institutions, may make those decisions on the patient's behalf. Sometimes a court may appoint a guardian. The decisions of these third parties might not exactly comply with those the patient would have made when still competent. Therefore, more people are stating their health care choices in writing in advance.

An advance directive is a document stating a person's health care choices or naming someone to make the choices on their behalf if the person becomes unable to do so. The specific legal documents by which this is accomplished are a Living Will and a Durable Power of Attorney for Health Care (DPA).

A thorough advance directive describes the kind of medical treatment a person would desire for different levels of illness or injury. For example, the directive would describe what kind of care a person would want if critically ill or injured, had a terminal condition or was permanently unconscious. An advance directive can specify both the medical treatments to be provided under certain circumstances and those to be withheld. Alternately, the person can also state that all life-sustaining procedures are to be used, no matter how ill the person becomes.

In order to make knowledgeable decisions, a person should talk to: their doctor about the effects of withholding or withdrawing different treatments, including life-sustaining procedures; their family, and; their attorney, if appropriate.

What happens if there is no advance directive?

If a patient has not created an advance directive and is unable to make or express his/her preferences, some state laws give decision-making power to individuals called surrogates. Surrogates are usually adult family members and can make some or all health care care decisions. Some states authorize an adult close friend to make decisions when family members are unavailable.

Even without such provisions, doctors and medical facilities usually consult close family members. In this manner, consensus is usually reached about treatment options. However, on occasion family members either may not know a patient's wishes or be unable to reach consensus. As a result, a doctor may become the decision-maker or the courts may have to resolve any disagreement.

While the decisions should be guided by the patient's desires, if those desires have not been communicated, even verbally, decisions made may be contrary to the patient's wishes. Family members and friends may endure unnecessary strife and grief attempting to make decisions without knowing the patient's preferences. It is better for all parties involved for a person to make their own values and preferences known and appoint an agent ahead of time through an advance directive.

Should everyone have an advance directive? Advance directives are most often created by elderly or seriously ill patients in order to reduce their suffering and provide the peace of mind that they are in control with regard to dying with dignity. However, because an accident or serious illness can happen suddenly, anyone may want to consider creating an advance directive.

How does a person write an advance directive?

Advance directives can be short, simple statements, as long as they are in compliance with state law. Most states have laws that provide special forms, signing procedures, witnessing requirements and restrictions on who can serve as your agent. Advance directives can be written by: a person simply stating preferences for medical treatment in their own words; use of a computer software package for legal documents; working with an attorney, or; using a form provided by the state.

Where should advance directives be kept?

The original should be put in a safe place and family members or others should be advised of its location. Copies should be given to family members and, if a Durable Power of Attorney for Health Care (DPA) has been executed, to the persons appointed as agent and alternates. The signer's primary care doctor and local hospital, if it accepts such forms, should also be given copies.

What if a doctor or medical facility will not comply with an advance directive?

If a doctor or medical facility will not comply with an advance directive, they must take all reasonable steps to arrange to transfer the patient to another doctor or medical facility willing to comply with the advance directive.

Can advance directives by changed?

Yes. They may be changed any time, as long as the person is still competent. Destroy the original and all copies of the prior advanced directive. Distribute copies of the revised advance directive to everyone who received the prior advanced directive.

Does an advance directive affect insurance or health care services?

Creation of an advance directive does not affect or modify any terms of a person's life or health insurance. Advance directives are purely voluntary and cannot be required by any individual or institution.

Are advance directives valid in all states?

Yes. There are laws in every state that provide for advance directives. While the laws vary by state, heeding the patient's wishes is the basic principle. Both the laws and the courts, which interpret and enforce the laws, place great emphasis on any form of written advance directives.