What is an Advance Directive?

If you are young and healthy, do you need an advance directive?

If you are in poor health, do you need an advance directive?

If you have discussed your wishes about health care decisions with your family, do you need an advance directive?

The answer is to each of these questions is “yes.”

Most people think such a document is only for those who are very sick or very old. That’s not true. It’s absolutely essential for anyone who is 18 years old or older.

Some (but not all) states have laws to cover a patient who hasn’t designated someone to make health care decisions. Such laws contain a “priority listing” of those who can make decisions for an incapacitated patient. But, in some states, those decisions may be limited to withholding or withdrawing treatment. They may not give the necessary authority to protect a patient. In other states, the law gives doctors the power to decide for patients if there are conflicts among those on the list.

An advance directive is a document by which a person makes provision for health care decisions in the event that, in the future, he/she becomes unable to make those decisions. There are two main types of advance directive — the “Durable Power of Attorney for Health Care” and the “Living Will.”

There are several kinds of provisions you can make within your Advance Directive for your care in case you become incapacitated:

  • Within your Durable Power of Attorney for Health Care you may name a health care proxy, someone else who is designated to make healthcare decisions on your behalf if you are unable to make them yourself.  The person you appoint as your agent will be able to make decisions only when a physician has certified that you are unable to do so yourself, and they cannot make end-of-life decisions unless you specify in advance.
  • Living Will: A Living Will is a written statement of your medical wishes, but it doesn’t designate another person to carry them out for you if you’re incapacitated.

A Do Not Resuscitate order is not part of an Advance Directive: a DNR is a separate, legally-binding order that instructs emergency first responders and hospitals to withhold CPR or advanced cardiac support.  It requires a special form issued by your local department of health and a doctor’s signature.  In many states, advance healthcare directives are not binding on prehospital services like EMS, and they may be required to attempt resuscitation if you don’t have a DNR.  It’s important to note that many have, or wish they had a DNR order.  This is a very important “wish” that deserves specific attention.  You may state within the “Living Will” section of your advance directive that you do not want to be resuscitated but the legal documentation must be in place and there are strict rules for posting the order.

When creating a healthcare proxy or advance healthcare directive, you can either consult a lawyer, or you can draw up the document on your own and take it to a notary to be witnessed.  The American Bar Association offers detailed instructions and a generic form for drawing up a healthcare power of attorney.  Your doctor will be able to help you set up a DNR and make sure you have all the correct forms.  You can revoke or change any of these documents at any time, so if your situation changes, you still have plenty of flexibility, and you will always be able to dictate your own care as long as you are medically able to do so.