Advance Directive

What Are Advance Directives

An advance directive, sometimes called a living will, is a document expressing a person's wishes about critical care when they are unable to decide for themselves. With an advance directive, individuals have the power to make future decisions about their own critical care without outside influence. A person who wishes or does not wish to be placed on life support can create an advance directive that hospital staff will follow should the person become incapacitated.

Understanding Advance Directives

An advance directive is a living will documenting one’s wishes for end-of-life medical treatment. The document instructs whether dialysis, breathing machines or tube feeding are desired, whether to resuscitate and whether to donate organs and tissue at the end of one's life. Planning ahead provides the medical care a person desires and avoids unnecessary suffering, disagreements and decision-making burdens during times of crisis. Two physicians must certify the person is terminally ill, seriously injured, in a coma, in the late stages of dementia or permanently unconscious and unable to make medical decisions before the living will is enacted.

An advance directive becomes legally valid in the United States after signing in front of a witness. However, emergency medical technicians cannot honor a living will; they must do everything in their power to stabilize a person for transfer to a hospital. Once a physician fully examines the person’s condition, advance directives can be implemented. Completing a new living will invalidates the old one. An advance directive should be updated periodically to stay current with a person’s changing end-of-care desires.

Advance Directive and Power of Attorney

A person appointed as medical power of attorney must be willing to ask challenging questions and needs to put aside emotions about a medical procedure or option to ensure the incapacitated person's end-of-life wishes are fulfilled. Openly communicating with one’s medical power of attorney about potential situations is important in clarifying end-of-life care preferences. Stating one’s opinion on tube feeding and hydration, receiving antibiotics, mechanical ventilation and aggressiveness of CPR are important topics. Other points of discussion are the person’s fears regarding medical treatments and under which circumstances the person might want more or less aggressive measures taken.

A durable power of attorney allows an appointed person to act as a person's agent and make financial decisions on the person's behalf in case of an incapacitating medical condition. The durable power of attorney makes bank transactions, signs Social Security checks, applies for disability and writes checks to cover bills. Different people may be designated to act on the person's behalf for different issues.