Guide to Advance Directives
Tools and Tips
What You Should Know About Advance Directives
What medical treatment would you choose if you had a stroke that left you completely
dependent upon other people? If you were terminally ill and near death, would you choose to
be resuscitated if your heart stopped beating?
While difficult, experts say it’s important to answer these questions, and share your answers with those close to you, so you receive the care you want in such situations -- even if you’re unable to communicate them on your own.
To ensure you receive the care that reflects your choices and values it is important to prepare an “advance directive.” Advance directive is a general term used to describe living wills and medical powers of attorney. Living Wills, sometimes called medical directives, outlines the type of care an individual wants in the event that they can no longer make their own medical decisions. Advance directives only covers health decisions. It does not cover financial decisions.
Although Advance directive policies are determined primarily at the state level, in 1991,
Congress enacted the Patient Self –Determination Act (PSDA). This act requires that all health care facilities receiving Medicare or Medicaid reimbursements must inform patients of their rights to make choices about the treatment they receive and to prepare advance directives.
The ideal advance directive includes a “durable power of attorney for healthcare” (DPAHC)
and a “living will.”
- A living will tells your advocate, physicians and other healthcare professionals what kind of medical treatment and care you would and wouldn’t want. Among other things, you may choose to specify in your living will that you always want the best possible “palliative” care—care designed to keep you as comfortable as possible.
- A durable power of attorney for health care (DPAHC) names the person you want to make treatment decisions on your behalf if you’re unable to make these decisions yourself. This person—known as a “surrogate” or “advocate”—is typically a relative or close friend. Before you prepare a DPAHC, you should make sure he or she is willing to make such decisions on your behalf. You should also specify what kind of medical care you do and don’t want (see “living will,” below, for more). In addition, if you want your advocate to be able to refuse care that’s needed to keep you alive, you must put this in writing in your DPAHC.
Healthcare providers will rely on your advance directive for guidance only when you are no longer able to make decisions about and tell them what kind of care you want. As long as you and your healthcare provider agree that you are able to make decisions about your treatment yourself, you will be able to do so.
Preparing an advance directive doesn’t have to be complicated. You don’t need a lawyer, but you can choose to have a lawyer help you. Different states have different laws concerning advance directives and you can find free DPHAC and living will forms for your state on the National Hospice and Palliative Care Organization Web site, www.nhpco.org. Just follow the instructions accompanying the forms to complete them. The best forms describe different medical situations, such as being in a coma, and list care options for each; you simply check the options you want.
These tips can also help you prepare an advance directive:
Talk to your relatives, friends, and healthcare providers and give them copies of your advance directive Explain your wishes so your family, friends, and providers understand and are prepared. It’s a good idea to make multiple copies of your advance directive and give them to your doctor, hospital, and loved ones. A copy should go into your medical record.
Keep a copy Put another copy of your advance directive in a safe, easy-to-find place, and let your loved ones know where it is. You may also want to put a note in your wallet explaining that you have an advance directive and where it can be found.
Review and revise your advance directive as needed. Advance directives do not expire. An advance directive remains in effect until you change it. If you complete a new advance directive, it invalidates the previous one. Over time, you may change your mind about what kinds of treatment you would, and wouldn’t, want. If you do, you should revise your advance directive and give everyone a copy of the new version.
DISCLAIMER: This information is not intended to diagnose health problems or
to take the place of medical advice or care you receive from your physician or
other healthcare provider. Always consult your healthcare provider about your
medications, symptoms, and health problems.
Last updated April 2012