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As life is unpredictable, older people often find themselves in situations where they get sick and their chances of recovery may be poor, such as after a stroke or advanced cancer diagnosis. However, if you’re in that position, you may not be able to express your wishes about medical treatments at the end of life, such as whether to start life support or CPR if your heartbeat or breathing stops.
While this topic is emotionally difficult, experts say that it’s important to have conversations about it with your family or friends. This makes sure that they are aware of your wishes and that you receive the care you want when you’re unable to communicate on your own.
To make sure you receive the care that reflects your wishes 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. Advance directives only cover health decisions. They do 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 healthcare 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.
Healthcare professionals will rely on your advance directive for guidance only when you are unable to speak for yourself or make decisions for yourself due to a severe illness. When you are in good health, and you and your healthcare provider agree that you are able to make decisions about your treatment yourself, you will not need the advance directives.
The ideal advance directive includes a “durable power of attorney for healthcare” (DPAHC) and a “living will.”
- A living will informs your close family or friends, physicians, and other healthcare professionals about the medical treatments and care you would or wouldn’t want if you were seriously ill and unable to make your decisions. It allows an individual to specify wishes about CPR, life support (such as artificial breathing on a ventilator), food and nutrition options (including feeding tubes), options to decline dialysis, and options for palliative or "comfort" care.
- A durable power of attorney for health care (DPAHC) identifies the individual whom you would like to make treatment decisions on your behalf if you’re unable to make these decisions yourself. This individual—known as a “surrogate” or “advocate”—is usually a relative or a close friend. Before you prepare a DPAHC, you should check with the intended advocates to make sure they are willing to perform these duties on your behalf in case it is necessary. You should also discuss your wishes regarding your medical care with the selected person. You can also write in the document what decisions you feel your advocate should be allowed to make, or not make, in these circumstances.
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’s website.
These tips can also help you prepare an advance directive
Talk to your healthcare provider. Discuss your healthcare wishes with your healthcare provider at routine appointments or a Medicare wellness visit, so they can help you complete your advance directives.
Talk to your family and friends. Explain your wishes to your family and friends so that they are aware of them. Holidays are a time of the year when families get together. While talking about your end of life wishes at Thanksgiving dinner might seem depressing, it helps you to make sure all your family members are aware of your wishes.
Talk often. Talk to your surrogate decisionmaker often about your wishes, including if they change. It allows them to make decisions in situations that may not have been mentioned in the living will.
Make multiple copies. It’s a good idea to make multiple copies of your completed advance directive forms. Give copies to your primary care provider, local hospital, and designated healthcare agent.
Keep a copy for yourself. Keep a copy of your advance directive in a safe but easy-to-find place. 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. Review and revise your advance directive as needed if your wishes and goals in life change. If you complete a new advance directive, it replaces the previous one. An advance directive remains in effect until you change it.
Last updated July 2019