Everyone knows that a last will and testament gives instructions for how to distribute your estate when you are gone. Most people know that a power of attorney will give the right to another person, appointed by you, to act on your behalf. Between the will and a power of attorney, you may think that your affairs will be managed if anything happens to you.
If you’re ever in a situation where someone needs to make a medical decision for you, and if you have any preferences about how your care should be managed, you need something more specific—an advance healthcare directive.
What is an advance healthcare directive?
An advance directive is essentially the combination of a medical power of attorney and a living will. It allows you to plan your own medical care instructions, as well as end-of-life wishes in case you are not able to communicate and are unconscious or terminally ill.
Rather than just turn over the decision—which can be very stressful—to someone you trust, an advance directive can both appoint someone to make healthcare decisions for you and gives instructions on what to do in specific situations.
Why would I need an advance directive?
What you might not anticipate is that between your doctors and your family, you could have a handful of opinions about what should be done, in the event that you have very little chance of regaining consciousness or lucidity. Leaving that decision entirely in the hands of your family and doctors can create a lot of conflict and stress among your doctors and family members, and you may not care for the result.
What happened to Terri Schiavo is a great example of an instance where an advance directive might have changed the outcome. After falling into a coma in 1990 and experiencing extreme brain damage, Schiavo’s then-husband and family battled in court for 15 years over whether or not to remove a feeding tube that was keeping her alive. An advance directive would have let doctors, family and the courts know her wishes in such a situation where her chances of regaining consciousness were essentially nil.
What can I include in an advance healthcare directive?
You can appoint someone to have the medical power of attorney to make decisions on your behalf, if you are unable to speak for yourself, while also giving specific instructions about certain issues.
Every state has different laws or policies specifying the priority for a medical decision-maker (or not) if something happens to you and you cannot make your own medical decisions. Some states do not specify a priority, others give first priority to spouse, then parents, etc, and some states allow the attending physician or advanced practice nurse to select someone lower in priority to make those decisions. If your priority is different than your state’s priority, that should be made clear in your advance directive.
You can also specify your preferences as to:
- Organ donation
- Access to medical records for your decision-maker
- Medical care, such are medical tests, surgery, and medicine
- Pain management, including authorizing or refusing certain medications or procedures
- Preferred assisted living facility, nursing home, hospital, or hospice care
- If you want a DNR (do not resuscitate) order if your heart stops or you stop breathing
- Where you want to spend the last days of your life (home vs. hospital, for example)
- Religious rites or rituals before or after you die
- Any other issue related to your medical care
How can I make sure my advance healthcare directive will go into effect?
Essentially, your advance directive must be signed, witnessed, and notarized. Requirements may vary by state. And of course, if there are any portions of the directive that are against your state’s laws or policies, then that portion of the directive may be unenforceable.
For example, if your advance directive requests, in certain circumstances, the administration of excess painkillers that would end your life, and assisted suicide is not legal in your state, then that portion of your directive would not be followed.
You should also know that your directive cannot force a medical provider or team to follow your wishes, although it can authorize your decision-maker to take an issue to court if they need to.
Earlier rather than later
End-of-life decisions tend to be something that people do not dwell on until they are retirement age or older. You never know when your time will be up, and having an advance directive in place can ensure that if anything happens to you, you can get the care you want and need and take the burden of some difficult decisions off of your family members.
Just like writing a will years before you ever expect it to be useful, you can have an advance healthcare directive now and update it as you age or as your preferences change.