Advance Directives

When it comes to your health, planning is crucial. Even if you are perfectly healthy, it is essential to consider what medical treatments you would want if you were too ill to communicate health care decisions. Putting advance directives into place can ensure you receive the type of care you would desire if you are ill and unable to express your wishes yourself.

What are advance directives?

Advance directives are legal documents used to guide the health care decisions taken by medical practitioners in the event of you becoming too sick to communicate. For example, this could apply if you were in a long-term coma, suffering from severe dementia, or terminally ill. Though older adults need to prepare advance directives, it is advisable for everyone, as unexpected severe illness can happen at any age. As well as ensuring you receive the type of care you would want, advance directives also serve to relieve your loved ones of the burden of making difficult decisions on your behalf and avoid the disagreement or confusion that could arise from this.  

What types of advance directives are there?

There are two types of advance directives: living wills and power of attorney. You can have just one of these, but they work best in conjunction with each other.   

Living will 

A living will is the most direct way to communicate your health care wishes. It is a written legal document prepared in advance to guide medical decisions in situations where you can’t share due to ill health. This document should address your preferences when it comes to common end-of-life and palliative care treatments. 

For example, your living will should state whether or not you would want to receive cardiopulmonary resuscitation (CPR) to restart your heart if it stops beating. While, of course, a potentially life-saving procedure, CPR can have severe side effects such as broken ribs and brain damage (particularly in the elderly), so it is crucial to consider whether you would want this procedure if you were critically ill. 

Other treatments to address in your living will include tube feeding, dialysis, and mechanical ventilation. It’s critical to look into each of these benefits and side effects when writing your living will. Although difficult to think about, it’s also essential to consider to what extent you would want your life prolonged. If you were severely ill and recovery was highly unlikely, how you feel about the risks and side effects of standard life-sustaining procedures. Doing so ahead of time can help save your loved ones from the heartache and uncertainty of having to make difficult decisions on your behalf.

Power of attorney

A durable power of attorney for medical issues, sometimes known as medical power of attorney, is a legal form where you name a person you trust to be your ‘health care agent’ (or ‘proxy’) and make medical decisions on your behalf. It is helpful to use this in conjunction with a living will to have somebody to advocate for you in unexpected health situations not covered in your living will. Your chosen health care agent should be somebody who knows you well and would be willing and able to make medical decisions in line with your wishes. It’s also advisable to choose one or several alternates in case your first choice is unavailable.  

How do I write an advance directive?

State laws regarding advance directives vary. Each state has its required forms and documentation that you must provide to create advance directives. Please speak to your local health care provider about finding the relevant documents for your state and for help filling them out. Make sure to ask your doctor all questions you may have about the medical treatments you wish to address in your advance directives. 

Once filled out, most states require advance directives to be signed by a witness to certify them. After completing your advance directives, store the originals in a safe, accessible place and provide copies to your doctor and family members. Consider keeping a small card in your wallet declaring that you have advance directives and stating where to locate the documents.

Changing your advance directives

Advance directives can be withdrawn or changed at any time. Indeed, it is vital to regularly review your advance directives to ensure your wishes remain the same. The process for updating your advance directives is similar to the process for creating them. It would be best if you spoke to your health care provider, fill out a new form with your updated medical preferences, and (in most states) have it certified by a witness. You should then destroy copies of old documents and re-distribute the updated directives to your doctor and loved ones. 

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