What Is an Advance Healthcare Directive?

September 12, 2017

No one wants to think about the likelihood of unfortunate events. Death, accidents, illness - we avoid these topics like the plague (both literally and figuratively). Why? Because they make us sad, because they make us uncomfortable, because sometimes superstition gets the best of us and we don’t want to tempt fate. But as difficult as they may be, these are important conversations to have with your loved ones or potential caregivers now, so that if and when the time comes, your wishes are clear. What we’re talking about is an advance healthcare directive. Here’s everything you need to know.

What is an advance healthcare directive?

An advance healthcare directive is a legally-binding statement for how you would like to be treated in the event that you are unable to make decisions for yourself. These important documents provide guidance for doctors and caregivers if you're terminally ill, seriously injured, in a coma, in the late stages of dementia, or near the end of life.

Who should have one?

Advance directives aren't just for older adults. As much as we hate to think about it, unexpected end-of-life situations can happen at any age, so it's important for every adult to prepare an advance care directive to be used when the unexpected occurs.

What are the different components of an advance healthcare directive?

Advance directives can vary based on state law and individual preferences (for an idea of your state’s advance directives click here), but, in general, they include two main components: the Living Will and Power of Attorney.

Living Will

A Living Will is a written, legal document that outlines future health care decisions should you become unable to make these decisions on your own. It takes effect only when a person has:

  • terminal illness (the patient cannot be cured) or 
  • permanent unconsciousness (often called a “persistent vegetative state”)

If you are mentally competent and can speak on your own behalf, or if there is a chance of recovery, the Living Will won't be used. You may revoke a living will at any time.

Things to consider:

A Living Will deals mainly with life-support treatments (i.e. any medical procedure, device, or medication designed to keep you alive when your body cannot do so on it's own) so when creating one it’s important to consider the type of medical treatment you would or would not want to receive (things like mechanical ventilation, tube feeding, dialysis, and do not resuscitate (DNR) or do not intubate (DNI) orders).

Consider your personal values (like the importance of independence and self-sufficiency) and what situation might make you feel that your life wasn’t worth living. Then talk to your primary care doctor, your health care agent, your family and your friends about your wishes. If you’re not sure how, resources for how to approach these conversations are available through the American Bar Association, the Conversation Project, and the Center for Practical Bioethics.

Be aware that you must create your Living Will yourself and you must be of sound mind for it to be legally binding. You can get a form from your state, and once it’s complete, have a witness (anyone over the age of 18 who is not your Power of Attorney) sign it. Store it in a safe place and hope that it never needs to be used, but that, if required, it’s ready to speak for you when you can no longer speak for yourself.

Power of Attorney

Similar to a Living Will, Power of Attorney (sometimes called a durable Power of Attorney for health care or a health care proxy) provides for situations where you are unable to make decisions on your own, in this case, naming a person to be your proxy to make those decisions for you. Unlike a Living Will, Power of Attorney can take effect even in the event that the patient does not have a terminal illness or permanent unconsciousness.

Things to consider:

It should be fairly obvious, but choosing a person to act as your health care Power of Attorney may be one of the most important decisions you ever make – this person will have the authority to make decisions about whether and what health care will be provided, withheld, or withdrawn when you are unable to speak for yourself.

Your Power of Attorney should be someone you trust with your life (quite literally) and who:

  • meets your state's requirements for a health care agent
  • is not your doctor or a part of your medical care team
  • is willing and able to discuss medical care and end-of-life issues with you
  • can be trusted to make decisions that adhere to your wishes and values
  • can be trusted to be your advocate if there are disagreements about your care

It’s important to talk to your Power of Attorney, not just before the document is signed (to make sure they’re comfortable taking on the role) but also after, in a continuous and open dialogue about your wishes. Also, be sure to name an alternate in case your Power of Attorney becomes unable or unwilling to act on your behalf.

Why is it important to have an advance healthcare directive?

Consider this, nearly 3 of every 4 Americans do not have an advance healthcare directive, and if the worst should occur, their loved ones (already dealing with sadness, grief, and shock) may not know how to act. By creating a directive and planning ahead, you can ensure you get the medical care you want, avoid unnecessary suffering, reduce confusion and disagreement, and relieve your family and loved ones of the burden of making difficult decisions during moments of crisis or grief.

Still not convinced? How about this - in 2016, Medicare began covering advance care planning (i.e. discussions between patients and their physicians or other health professionals regarding end-of-life care and preferences) as a separate and billable service. So now there’s no excuse. Talk to your physician, your health care providers, and your loved ones today, and make sure that if and when the worst occurs, you’ll receive the care you want and none you don’t.

For more information on care programs, advance planning, and preventive medicine, visit MD-athome.com, the premier healthcare resource for homebound patients in Chicago and the Chicagoland area.

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