Advance Directives

What is an advance directive?

An advance directive tells your doctor what kind of care you would like to have if you become unable to make medical decisions (if you are in a coma, for example). If you are admitted to the hospital, the hospital staff will probably talk to you about advance directives.

A good advance directive describes the kind of treatment you would want for different levels of illness. For example, the directives would describe what kind of care you want if you have a critical illness, a terminal illness or permanent unconsciousness. Advance directives usually tell your doctor that you don’t want certain kinds of treatment. However, they can also say that you want a certain treatment no matter how ill you are.

Advance directives can take many forms. Laws about advance directives vary from state to state. You should be aware of your state laws regarding the scope and requirements that apply to advance directives.

What is a living will?

A living will is one type of advance directive. It only comes into effect when you are terminally ill. Being terminally ill generally means that you have less than six months to live. In a living will, you can describe the kind of treatment you want in certain situations. A living will doesn’t let you select someone to make decisions for you.

Should I have an advance directive?

Most advance directives are written by older or seriously ill people. For example, someone with terminal cancer might write that she does not want to be put on a respirator if she stops breathing. This action can reduce her suffering, increase her peace of mind and increase her control over her death. You might want to consider writing an advance directive even if you are in good health. An accident or serious illness can happen suddenly, and if you already have a signed advance directive, your wishes are more likely to be followed.

How can I write an advance directive?

You can write an advance directive in several ways:

  • Use a form provided by your doctor.
  • Write your wishes down by yourself.
  • Call your state senator or state representative to get a form.
  • Call a lawyer
  • Use a computer software package for legal documents.

Advance directives and living wills do not have to be complicated legal documents. They can be short, simple statements about what you want done or not done if you can’t speak for yourself. Remember, anything you write by yourself or with a computer software package should follow your state laws. The orders should be notarized if possible, and copies should be given to your family and your doctor.

What is a durable power of attorney?

A durable power of attorney (DPA) for health care is like a living will, but it becomes active any time you are unconscious or unable to make medical decisions. In a DPA, you select a family member or friend who will be your medical decision-maker if you become unconscious or unable to make medical decisions. But a DPA may not be a good choice if you don’t have another person you trust to make these decisions for you.

Living wills and DPA’s are legal in most states. Even if they aren’t officially recognized by the law in your state, they can still guide your loved ones and doctor if you are unable to make decisions about your medical care. Ask your doctor, lawyer or state representative about the law in your state.

What is a do not resuscitate order?

Do not resuscitate (DNR) order is a request not to have cardio-pulmonary resuscitation (CPR) if your heart stops or if you stop breathing. (Unless given other instruction, hospital staff will try to help all patients whose heart has stopped or who have stopped breathing.) You can use an advance directive form or tell your doctor that you don’t want to be resuscitated. In this case, a DNR order is put in your medical chart by your doctor. DNR orders are accepted by doctors and hospitals in all states.

Most patients who die in a hospital have had a DNR order written for them. Patients who are not likely to benefit from CPR include people who have cancer that has spread, people whose kidneys don’t work well, people who need a lot of help with daily activities, or people who have severe infections such as pneumonia that require hospitalization. If you already have one or more of these conditions, you should discuss your wishes about CPR with your doctor, whether in the doctor’s office or when you go to the hospital. It’s best to do this early, before you are very sick and are considered unable to make your own decisions.