What You Need to Know About Advance Directives
- Do you or a loved one have an advance directive? Living wills help ensure your wishes are followed if you are ever seriously ill. Learn about this helpful tool.
What Is an Advance Directive?
Advance directives are a powerful tool for people who want to make sure their wishes are followed if they ever become seriously ill. Sometimes called living wills, these documents put your directions for medical care into writing before the important decisions have to be made. Sometimes, an advance directive designates a person you trust with the power to make medical decisions on your behalf.
What Are the Types of Advance Directives?
The term advance directive describes a large family of documents you might want to have on hand in case you need them. Some directives focus on just a single topic, such as whether or not to resuscitate you in an emergency, while others can get very detailed about how you want your care to be managed. Though there are different types of advance directives, some documents fold several categories together into a combined directive.
A living will is one of the more common forms an advance directive takes. This document describes in as much detail as possible how you want your medical care to be provided, in the event that you are in a coma or otherwise unable to direct your care.
Living wills can get complex, as various medical procedures are described in it and your wishes made clear. Sometimes, your wishes are conditional, such as authorizing a breathing tube if the doctor thinks you have a good chance of recovery, but not if your condition is too far along for a full recovery. Living wills often describe the specifics of your care, including whether you want:
- Use of a respirator to keep you breathing
- Blood transfusions
- Extensive use of painkillers or palliative care
- Fluids administered via IV or gastric tube
- To arrange for the donation of your organs, in the event you do not survive
Medical Power of Attorney
You can’t anticipate every possible medical situation in advance, which is why you can assign medical power of attorney, which is sometimes called durable power of attorney, to someone you trust to make decisions for you. The person you give power of attorney to is theoretically someone who has your interests and wishes at heart, and who can direct your care as if you were making the decisions yourself.
Ideally, a person you designate with power of attorney should be close enough to get to the hospital if you’re in an accident, or at least be reachable during the time when you’re in hospice, as decisions that affect your care may have to be made on very short notice.
Physician orders for life-sustaining treatment (POLST) forms are not used in every state, but in some places they can be very helpful. POLST forms are very specific sets of instructions for how you want your immediate emergency care to be handled by first responders. Paramedics, EMTs and other emergency responders are not able to follow your other advance directives, which are written for hospital and other non-emergency staff to follow. They can obey a POLST, however, since the document contains the direct instructions of a licensed doctor (your own doctor, who must sign the form), telling them what specific measures to take in order to revive you.
You can use a POLST to refuse CPR, choke rescue techniques (think Heimlich Maneuver), rescue breathing or emergency oxygen, intubation, defibrillation and other on the spot lifesaving measures. People with terminal illnesses may choose to keep a copy of their POLST on them during trips outside of the home, in case they have an emergency and do not wish to be resuscitated.
Without a valid POLST that is physically present on the scene, which medical staff can read with their own eyes, first responders must do what they can to stabilize you for the trip to the hospital. EMTs and paramedics absolutely cannot take someone’s word that you have a POLST; you must have it with you at the scene in order for them to follow it.
Do Not Resuscitate (DNR)
A DNR is the final directive you can give to medical workers regarding your care. This document excuses your health team from their usual duty to take heroic measures to restart your heart or to provide oxygen if you stop breathing. A person who has a DNR on file with their medical workers or hospice team will not be given lifesaving measures, but will instead be allowed to pass away naturally.
Why Should You Have an Advance Directive?
People create advance directives for many reasons. Some people have a preference for where and how they will be treated, and they draft a document stating their wishes. Sometimes people write DNRs as part of the hospice experience, in order to ensure they pass away without too much medical intervention.
You might assign medical power of attorney to a spouse or other trusted person just in case something unexpected happens. Some people compose limited advance directives for a single issue, such as to make sure they don’t get a blood transfusion, or people who want to guarantee their organs can be donated if they suddenly pass.
What Happens if You Don’t Have an Advance Directive?
Medical and rescue workers have a set of guidelines they must follow in most cases. These are called protocols or standing orders. If your condition prevents you from making your wishes known, the presumption of the standing orders is that you want every measure possible to be taken to preserve your life.
Without input to the contrary from you, medical workers have a duty to keep your heart beating as long as possible, and to take whatever invasive, expensive or painful measures are needed to keep you alive, even if it’s only for a short time. Your advance directive overrides that duty and allows medical staff to deviate from the usual protocols in your care.
How Do I Get an Advance Directive?
While you can draw up an advance directive on your own (the AARP provides free printable advance directives by state), it’s a good idea to have an attorney who works in healthcare law help you with it. If you want your directive to be enforceable, most states require that the document has your signature and that of witnesses, including a notary, in many cases. States put limits on who may be a witness, and your POLST must be signed by a licensed medical doctor in good standing to be valid. Ask an attorney about drafting an advance directive, and give copies to the people who are most likely to be there when you need them.