Advance directives are written instructions about your future medical care. They do not go into effect until you are no longer able to make decisions. Advance directives can help in several ways:
Three examples of advance directives are:
It is best to prepare advance directives when you are healthy rather than when you have been very ill or are in the hospital.
A living will is a legal document that states your wishes for treatment when you have a terminal illness. Terms in the living will may go into effect when:
Living wills tell caregivers what to do if you become unable to make healthcare decisions yourself. It is called a living will because it must be signed formally like a regular will but its terms go into effect before your death.
A living will may:
Living wills cover decisions about your healthcare only when you have a terminal illness. Some illnesses, such as stroke, may not be covered by a living will.
Living wills may not always be binding. Most but not all states have laws that recognize advance directives. Some states do not recognize living wills that have been drafted in other states. Check the laws in your state.
A durable power of attorney for healthcare (DPOA-HC) is another legal document regarding medical care. It appoints a family member or friend to make medical decisions for you if you cannot make them for yourself. This person is called your agent. Your agent should be someone who will follow your wishes. In states that recognize these documents, families and healthcare providers cannot override your stated wishes or your agent's decisions. Some people prefer the DPOA-HC to a living will because it is more flexible.
You must be legally competent at the time you sign a DPOA-HC for it to be legal. If you have a brain disease that gets worse over time (such as Parkinson's disease or Alzheimer's disease), you may wish to create and sign the DPOA-HC papers early in the illness.
Once you have signed a living will and DPOA-HC, keep them in a safe place. Do not put them in a safe deposit box because others may not have access to them when the documents are needed. It is a good idea to discuss your wishes with your friends, family members, and your healthcare provider. Give these people copies of your living will or DPOA-HC. Then they will have easy access to the documents if they are needed.
There are various ways to get forms for advance directives. For example:
If you are in a clinic, hospital, or nursing facility, you may be asked to sign a code status sheet. The code status sheet tells the staff what you want to be done if your heart stops and you are not breathing.
A DNR order applies only to emergency treatment in case of collapse. Having a signed DNR order does not keep healthcare providers from doing other types of treatment, such as more antibiotics for an infection or more treatments for advanced cancer.
It can be helpful to have nonhospital DNR orders if you live at home alone or in a nursing home or adult care home and you do not want to have emergency treatment if your heart stops or if you stop breathing. Emergency medical teams that come to your home by ambulance are not allowed to stand back and not treat you unless they have DNR orders for you. In some states you are expected to keep a copy of the DNR order by your bedside, on your refrigerator, or on the inside of your bedroom door. Emergency medical staff are trained to look in these places for your instructions. In other states, you wear a DNR bracelet.
To create DNR orders for places other than a hospital, talk to your healthcare provider. Special forms called Orders for Life Sustaining Treatment can be prepared for you to keep at home and at your provider’s office.
Advance directives are legal only if you signed them when:
You are legally competent if you are of sound mind and at least 18 years old. All adults are presumed competent unless a judge or a court has declared them incompetent. A person can be confused about time and place but still be able to understand choices if they are carefully explained. Legal competence is based on whether you:
Healthcare providers and mental health specialists can help assess your ability to make decisions. Requirements for competency vary from state to state.
Usually the witnesses to the signing of your directives must not be:
The court may appoint a legal guardian if you are not able to make informed decisions. Guardianship may cover all areas of your life, or it may cover only certain areas. For example, you may be able to make decisions about your health but not about money.
Give copies to your family and to your primary healthcare provider. If you see several providers regularly, like an internist and a cardiologist, give them both a copy. Put a copy in a bright envelope in your home. Then put notes by your bedside and on the refrigerator or on your bedroom door telling people where to find your documents. Always take copies with you if you go to a hospital or surgery center for treatment.
Although death comes to everyone, many of us fear it and may avoid dealing with issues that concern the end of life. It is important for you to put your wishes in writing. Otherwise, your wishes might not be known and then cannot be honored. That can make it even harder for loved ones when you are very ill. Take care of yourself and your family by making decisions about medical care while you are able to do so.
