Advance Care Directive

What Is An Advance Care Directive & Why You Should Care

An advance care directive is a legal document that outlines what actions should be taken for people if they are no longer able to make the decisions themselves. 

This goes into effect when the person is mentally incapable or unable to communicate due to a serious injury or illness.  

You might have heard these other names for an advance care directive: living will, personal directive, advance directive, medical directive or advance decision. In the United States, it has legal status. However, in other countries, it may be legally persuasive but not classified as a legal document.

Types of Advance Care Directives

a hospital patient holding the hand of a loved one while discussing advance care directive with doctor

There are 3 types of advance care directives. Enduring power of attorney and health care proxy should be separate documents, but they are often combined into one.

  1. 1
    A Living Will - A written form that leaves instructions for your treatment when in the hospital. It can be very specific or very general.
  2. 2
    Health Care Proxy - This legal document allows someone to make decisions on your behalf if you’re unable to do so yourself. The health care proxy can request or refuse treatment based on what you would do if you were capable.
  3. 3
    Enduring Power of Attorney - This legal document gives someone else your power of attorney when you are medically unable to do so. The enduring power of attorney allows the person to sign and write checks and make bank transactions when you can’t make them yourself.

The History Behind the Advance Care Directive

The increasing advances in medical technology and care spurred the creation of the advance care directive. A number of studies have found medical care for the dying is inadequate. In many cases, care was found to be painful, expensive, and emotionally trying for patients and their families.

If you don’t have any medical issues now, discuss your family history with your doctor. They will be able to help you determine whether you should worry about planning for any of those medical conditions in your future. 

These conversations are free during your annual wellness visit if you have Medicare. If you have private insurance, check with your provider to make sure it will be covered.

When considering what to include in your advance care directive, really think hard about...

What is more important to you?

Do you want to live as long as you possibly can, no matter your condition?

Or, do you want to only be kept alive if your quality of life will be good?

How to Start Planning Your Advance Care Directive

Start by thinking about what kind of treatments or medical care you want if an emergency situation arises. It’s a good idea to talk to your doctor about any current medical conditions that might play a factor in your future decisions. Talking it out will help you understand things better, so then you can put your wishes in writing when you prepare your advance care directive.

There are an endless number of situations that could arise, for instance...

  • What if you have a stroke?
  • What if you’re in constant pain for the rest of your life due to an accident or illness?
  • Should life-saving measures be taken if your heart stops?
  • What if you’re in a coma and can’t breathe on your own?

These are all things you need to think about and put in writing in your advance care directive. If you do this, then your family will know for sure what you want if you can’t speak for yourself.

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What to Include in Your Living Will

Your living will should cover a variety of end-of-life care decisions.

Note...It is important to understand that deciding not to have aggressive medical treatment is very different from refusing all medical care. A person can still get treatments such as antibiotics, food, pain medicines, or other treatments. It is just that the goal of treatment becomes comfort rather than cure.

Here are some of the topics you should include:

  • Cardiopulmonary resuscitation (CPR) - List the cases in which you would want to be resuscitated with CPR or by a device that shocks your heart.
  • Mechanical ventilation - Consider if you want a machine to take over if you can’t breathe on your own.
  • Tube feeding - If you can no longer eat on your own or with help from someone, decide if getting your nutrients through an IV or a tube in your stomach is acceptable to you.
  • Dialysis  - This treatment would be necessary if your kidneys stopped functioning to remove waste from your blood and manage your fluid levels.
  • Antibiotics and antiviral medications - Medications can be used to treat many infections, but you need to think about how aggressive you would want your treatments to be.
  • Comfort care (palliative care) - This is meant to keep you comfortable and manage your pain. It might include being allowed to die at home, getting pain medications, and avoiding invasive tests or treatments.
  • Organ and tissue donations  - If you choose to donate your organs, make sure you let your health care proxy know it is OK to keep you alive until the procedure has taken place.
  • Donating your body  - You can choose to donate your body for scientific study. You should contact a medical school or university if you are considering this option.

Details You Need to Know about Living Will & Health Care Proxy

As mentioned above, these can be two separate advance care directive documents. However, they are often combined into one document. When you name a health care proxy, that person can make medical decisions on your behalf if you are unable to do it yourself.

Some of those decisions include:

  • Agreeing to or refusing any medical treatments or procedures
  • Hiring and firing medical providers
  • Admitting you or discharging you from a hospital or medical care facility
  • Accessing your medical records
elderly woman in hospital bed with husband and daughter by her side discussing advance care directive

How Should I Choose a Health Care Proxy?

Make sure you know the rules in the state you live in. In many states, you can’t name your doctor as your proxy, so that’s not the best idea. Choose someone who is trustworthy and who you can easily discuss end-of-life issues with. You need to make sure the person knows exactly what you want to happen and will follow through with your wishes.

It’s best to choose just one person to avoid disagreements about your wishes. You can name a backup, though, in case anything should happen to your first choice.

Making Your Advance Care Directive Official

Once you have talked everything over with your doctor, it’s time to put your wishes in writing. There are legal forms you need to fill out, but it doesn’t mean you need a lawyer. There are different forms, depending on which state you live in. Check with your local Agency on Aging to get the forms. 

Again, depending on where you live, your advance care directive might need to be witnessed. And in some states, your signature might need to be notarized. Oftentimes, a notary can be found at a bank, post office, or your local library. Keep in mind, some might also charge a fee to notarize documents.

Updating & Changing Your Advance Care Directive

It’s possible to make changes at any time. But, remember you need to destroy all the old copies of your documents. Make sure to discuss these changes with your doctor, and that the new advance care directive form is in your medical file.

If you happen to be in a nursing home or hospital, the new directives can be added to your medical chart. Make sure you discuss the changes you’re making with your health care proxy, family, and friends.

Consider updating your advance care directive in the following situations:
  • A new medical diagnosis - If you are diagnosed with a terminal illness or a disease that will drastically change your quality of life, discuss your treatment options with your doctor.
  • Marital status change - If you get married, divorced, separated, or are widowed, you might need to change who is in charge of your health care decisions.
  • 10 years pass - As you age, your ideas of what you want your end of life to look like may change. Review your advance care directive from time to time to make sure it still matches with what you want.

An advance care directive can be revoked at anytime as long has you have mental capacity to do this.

Why It’s So Important to Protect Yourself

If you don’t outline your wishes ahead of time, you won’t be protected when something serious happens. It’s important to talk with family and friends about what your wishes are if you are unable to make health care decisions for yourself. 

It’s even more important to have everything in writing in your advance care directive. If you don’t put it in writing, family members and doctors will be left to make decisions for you. This can cause arguments and might not lead to the same decisions you would have made. It can put an enormous amount of responsibility on your family which may result in feelings of guilt.

What to Do After Everything Is Set Up

Once you have all the documents in place for your advance care directive, make sure to make copies of everything. Your health care proxy and alternate proxy, if you named one, should be given copies. Give one to your doctor to include in your medical records. If you have to go to the hospital, make sure the staff there has a copy as well.

It’s also smart to keep an extra copy of your advance care directive filed online with My LifeJars and provide permissions for your Health Care Proxy and your Doctors access to this copy. Our app offers you a safe and secure place to keep your important documents all in one place and provides a record of the latest document if you have updated it. .

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