Step 1 Understand and Complete Your Advance Directives

Helpful information to get you started 

Ask Abby

If you are 18 or older, you are at risk of losing the ability to make your own healthcare decisions — unless you have signed a form that protects you if you are ever unable to make your wishes known.

" When I got sick and was away at school, my mother was able to get information because I carried a form with me that she is my medical power of attorney." — A Student

Complete Your Advance Directives

WHAT ARE ADVANCE DIRECTIVES?

The Merriam-Webster Dictionary definition: “A legal document (such as a living will) signed by a competent person to provide guidance for medical and health-care decisions (such as the termination of life support, or organ donation) in the event the person becomes incompetent to make such decisions.”

According to the Mayo Clinic, “Advance directives guide choices 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.”

WHAT KIND OF ADVANCE DIRECTIVES ARE THERE?

Terms vary around the country but there are three basic types of advance directives. 

Health Care Proxy/Agent or Surrogate Decision-maker
Most states have laws that specify the requirements for authorizing another person to make medical decisions on your behalf.  This may include the specific form or language to be used in the actual document. This type of advance directive allows you to designate a person of your choosing to make healthcare decisions on your behalf in the event that you are unconscious, cognitively impaired or unable to communicate your wishes due to injury or illness.  These discussions and decisions can be difficult, but it is essential that you discuss your preferences openly and honestly in advance of completing the forms. Copies of the completed form should be shared with your doctor, appointed proxy, other family members and your local hospital (if you have received medical care) or other health care providers (SNFs, Home Care, specialists, etc), as appropriate.

Most proxy and surrogate forms allow you to specify specific wishes & preferences  to guide your designated person, but they are free to use their own judgment to decide what is in your best interest.  A copy of this document must be produced and given to a health care provider (doctor, nurse, EMT, ER staff, etc…). The AMA recommends that you keep a Wallet Card with the name and phone number of your designated person so emergency personnel easily and quickly contact them on your behalf in an emergency situation.

Wallet Card

Living Will or Durable Power of Attorney
Both state and federal laws govern the requirements for Living Wills or Durable Powers of Attorney.  Despite different names, these legal documents carry the weight of law when they are properly executed and duly notarized.

A Living Will specifies & authorizes certain actions designated by an individual related to the individual and his/her property.  A Durable Power of Attorney grants another person the legal authority to make decisions on behalf of an individual relative to two aspects of authorized decision-making:  Actions and authorizations related to (1) the Person and/or (2) the Property of the individual named in the document. The powers authorized may be specific or all-encompassing, based on the wishes of the individual executing the document.  Copies may be shared with all parties involved, your attorney and other family members, as appropriate.

Medical/Physician Order for Life-Sustaining Treatment (MOLST / POLST)
This is a Physician Order specifying a patient’s personal preferences related to end-of-life care.  Most states require that your doctor complete a specific state form (sometimes states even specify the color paper the form must be printed on) for the MD Order to be valid.  You will need to have an in depth discussion about your wishes and preferences with your doctor. Be sure to review your state’s POLST form in advance and write down your questions before you schedule a meeting to discuss this with your doctor.  These are important decisions. Take whatever time you need to get answers to your questions, understand your options and make informed choices about your care.

State by State POLST

How do I do it?

1. Fill in a form. Forms are available in many places online. Here are a few choices:

  1. In many states two witnesses and/or a notary must sign the form to make it legal. Find your state’s requirements here.
  2. Give copies to family members, your health care agent, your doctor(s) and your hospital or care facility.
    More information on creating a living will here

Advance Directives - Talking Points

Advance Directives allow a person who is unable to speak for him/herself to assert their right to make informed decisions by authorizing a trusted person to make decisions on their behalf.

Can you think of any situations in which an advance directive is needed?  

  • Your child turns 18 and becomes unconscious or stops breathing (due to a choking incident, a car accident, a swimming accident, a sports injury, intoxication, etc…).  Will the hospital/ER share confidential information with you about your adult child?  Who will make critical decisions about urgent care?

  • A young adult goes away to college (near or far) and has a medical emergency that requires urgent medical care.  Who makes decisions if he/she cannot?

  • A chronic illness or condition causes a decline in cognition (dementia, Parkinson’s Psychosis, a severe infection, Schizophrenia, Psychotic episode, etc..).  Who decides on treatment options and care plan decisions?  

  • A cancer patient is terminally ill and becomes unable to make decisions about his/her care.  Who has the authority to make decisions on his/her behalf?

In each of the above situations, who knows the patient’s preferred wishes and is authorized to have the medical team carry them out?

It is important that you take the time to discuss these issues with your doctor and/or family, if appropriate, to make sure your wishes are known and you understand your responsibility and authority to carry out an advanced directive.

What Does a Healthcare Surrogate or Proxy Do?

A healthcare surrogate or proxy is a person designated by a family member or friend to make their medical decisions for them if they cannot speak for themselves or are not able to make their wishes or preferences known. The person may be incapacitated temporarily, for example after an accident or while under anesthesia or sedation during surgery. They may be affected by a permanent condition such as dementia or at the end of life with incurable cancer. Ideally a person shares their beliefs and preferences in advance as they go through the process of choosing a surrogate or proxy and completing the form which makes their choice clear for the medical team. This conversation may also occur at the time of injury, illness, or when the person is diagnosed with a life-threatening condition.

Discuss Ahead of Time

  • The person's medical condition and preferred treatment options

  • The person's preferred medical team and hospital

  • Review the person's medical chart together if appropriate

  • Access to and approval for release of the person's medical records

  • Requesting and coordinating second opinions or outside medical care

  • Preferred family, friends, and faith leader for support

The conversation need not be about death and dying. It is about beliefs and preferences. People who do not want to discuss dying may see this as an opportunity to explain what they would want if a choice must be made when they are not able to communicate for themselves. The surrogate will be expected to know the person’s wishes and approve or decline:

  • Types of medical care including experimental intervention, medicines, or surgery

  • Blood transfusions

  • Life-support treatments including feeding and mechanical ventilation

  • Pain management even if it may shorten their life

  • Where the person will receive care and treatment, possible transfer to another hospital, or state, or to a nursing home or hospice facility

  • Whether or not to allow organ donation

More Questions for the Conversation

“I hope we never have to know this, but do you want to donate your organs?”  or “How do you feel about organ donation?”
“If you had a brain injury that left you with very limited functioning, would you want tube feeding or breathing machines to keep you alive?”
 “I know this is unlikely, but if the operation shows an unexpected problem which could affect your fertility, would you rather the surgeon take care of it while they are in there? Or stop and wake you up to allow you to decide what you want done in a later operation?”

These are just a few examples of the wide variety of topics that may be discussed by a person and their healthcare surrogate or proxy, depending on the circumstances. Sharing your own thoughts during the conversation might be helpful. There are online and in-person programs and services available to assist any person or family exploring the considerations and choices involved in designating a healthcare surrogate and completing Advanced Directives.

Individual States: