What Is An Advanced Directive?
An Advanced Directive is a legal document that informs your health care professional what decisions you would like made on your behalf should you not be able to make those medical decisions on your own. Should you be in a coma, or otherwise not of sound mind or body, this advance directive will inform hospital staff of your wishes as to what medicals steps should be taken or avoided.
An advanced directive may include information on specific treatment based on the reason for your admittance to the hospital. This may include treatment that you do not desire, such as heroic acts that may sustain your life, but not improve your quality of life.
In the case of an illness you are unlikely to recover from, an advanced directive may inform medical professionals when to stop treatment. An advanced directive may inform medical staff who has the power to make decisions on your behalf when you are unable.
Each state has separate laws for advanced directives, so it is important to review your local laws when creating your documents. It is also important to check whether or not a notary will be required for the document to be considered legally binding.
What Are The Types of Advanced Directives?
There are several advanced directives available and recognized in the United States. These include:
Living Will - a living will is a written, legal document specifying what medical treatments or life-sustaining treatments you desire should you be terminally ill or incapacitated. A living will becomes effective once you become incapacitated, and not before. As long as you are of sound mind and able to make medical decisions on your own behalf, a living will is not in use.
In some states, certification by the doctor who is providing your care is required before the living will can be activated. Temporary incapacitation will not automatically initiate the living will. For example, should you have a heart attack and temporarily be unable to make decisions, a doctor would need to declare you incapacitated before the wishes stated in the living will could be followed.
Typically, a living will is used to remove life prolonging procedures when ultimate recovery is not likely to happen as declared by at least one medical professional.
You may choose an executor of your living will, but not every state will recognize that person as someone who can make legal decisions on your behalf. An executor typically makes the final call on removing life-sustaining machines when it is determined that your quality of life is beyond recovery. Often, a living will is accompanied by a power of attorney in case the state in which you live in does not recognize the executor of the living will.
Please check your state laws to ensure your documents are in order.
A living will may include a clause that would override an order to cease treatment. An example of this is a pregnancy that at least one doctor concludes can be carried to term even if the mother shows no signs of recovery. In a case such as this, the directive to remove life-sustaining machines would be inactive, but once the baby is out of the womb the directive will be reactivated.
A Living Will is not the same as a Last Will and Testament, which is a a legal document directing how to distribute your estate after your death.
A Living Will is ALSO not the same as a Living Trust, which is a legal plan for holding, then distributing an individual's assets in order to avoid probate following the individual's death. Those two documents are not discussed here, as they relate to your material goods and not your health.
Power Of Attorney (POA) - a power of attorney is a legal document giving an individual the power to act on your behalf at any point that you are unable to do so yourself.
A durable power of attorney is a legal document allowing you to state a chosen person to make health care decisions on your behalf. This legal document becomes automatically active at any point that you are unconscious or incapacitated to make sound medical decisions.
The power of attorney, or health care proxy, will work with your doctors to ensure you receive the best care possible. If you also have a living will in place, the POA will use the directives in the living will to provide the services that you desire, or to cease the services that you wish to refuse. There are a few states that combine the power of attorney with the living will for ease, called an Advance Health Care Directive.
It is important to note that a power of attorney does not automatically include medical decisions alongside the financial decisions should you become incapacitated.
However, a durable power of attorney gives permission for medical and financial decisions unless you have a separate POA specific to your finances. Should you use a durable power of attorney for both medical and financial decisions, that trusted person is called an attorney-in-fact regardless of whether they are a licensed attorney (as they do not have to be).
Do Not Resuscitate Order - also known as A DNR, is a legal request to not receive cardiopulmonary resuscitation (CPR) should your heart stop pumping blood or your lungs stop breathing. Until a DNR is provided, hospital staff will assist by all means available if a patient's heart stops beating including providing CPR. You can use another advance directive to include a DNR order, as well as sign one when you enter a hospital facility if you are able.
Doctors and hospitals in all states must accept DNR orders.
Many people believe that a DNR is equal to terminating the care for a patient. This is untrue.
In reality, a DNR simply means that if a patient goes into cardiac arrest, CPR cannot be started if a DNR is on file for that patient. Medical staff do not differentiate between somewhat healthy patients and terminally ill patients. Standard medical care will always be provided including ventilators, artificial hydration (IV fluids), and even a feeding tube as needed.
Allow Natural Death - a somewhat controversial request, which is not the same as a DNR Order, in which the patient desires to remove all life sustaining equipment in order to die a natural death. It is not considered euthanasia, however not all medical professionals agree with the practice. Only measures to provide comfort, such as nutrition and hydration, will be provided to the terminally ill as their life begins to wane. Ventilators and other life-sustaining machines are removed when allowing for a natural death.
Allow Natural Death measures are currently primarily used in hospice care and nursing homes.
How Do Advanced Directives Work?
Advanced directives are activated once a person becomes incapable of making their own medical decisions. However, the documents are useless if the medical professionals are not aware of them.
Ensure your family doctor is aware of your wishes.
Provide a statement to your employment's Human Resources department to be placed in your personnel file alongside emergency contact information. The statement should include what advanced directives you have in place, and who to contact regarding them.
In several states, living will registries exist for you to properly document your paperwork. You should also provide your health care proxy, or POA, a copy of the legal paperwork.
You may want to consider purchasing online medical record storage which allows you to input your medical history, including attaching advanced directives. If you do so, you are provided a card to keep in your wallet for medical professionals to gain access to your information. The access card will allow for read only access, as your password is required to make any changes to the data.
Additional Advance Directives Resources:
US Living Will Registry is a website where you can register your living will for easy online access for family and medical professionals.
US Legal Forms provides basic information on advanced directives, and links to the various state specific forms for advanced directives.
Online Medical Record Storage: websites where you can store your medical information for easy online access. You will receive a card to carry in your wallet or on your keychain that includes a view only access code for medical professionals to easily see your medical history and legal documents.