What is an Advance Directive?

When a person has a serious or life-threatening illness, it’s vitally important that he or she makes his intentions and wishes clear and documented. This can be achieved through an advance directive.

There are two main types of advanced directive: a living will and a power of attorney. In a living well, a person can leave detailed instructions about his or her preferences when it comes to certain kinds of life-sustaining treatments, such as tube feeding, resuscitation, and mechanical respiration. A power of attorney directive names a trusted party to act as that person’s agent if he or she is unable to speak for him or herself.

Living Wills

A living will allows a person to specify what type of medical intervention they want and do not want in the event that they are unable to convey their wishes at the time when the intervention is needed. There are a number of issues that need to be considered when writing a living will:

  • In some cases, pain relief options may ease the patient’s pain but may also shorten that person’s life. Do you approve the use of such pain relief on yourself?
  • Which life sustaining options do you approve of, and for how long should they be used. Issues to consider here include tube feeding, CPR, mechanical ventilation, and antibiotics.
  • If doctors determine that you are irreversibly brain dead, do you want artificial life support to be maintained until your heart stops beating, or do you want it removed?
  • How do you feel about organ donation?
  • How do you want your body disposed of after death? Is there a certain funeral home or other organization you want involved? Do you have requests for your funeral or memorial service?

These are very heavy questions, and you may worry that you have left something out. However, each state has a very detailed living will form, allowing people to accept or reject certain issues. If one of your wishes is not included in the form, there is also an area where signers can add additional information or concerns.

Power of Attorney

Some patients feel that assigning power of attorney is more flexible than a living will, because there is no way to anticipate all possible medical decisions that may need to be made.

When assigning a medical power of attorney, it is important to select a person who you know will carry out your wishes, even if their own wishes differ. Also be sure to select a person who is comfortable with medical professionals and who will ask the difficult questions, and who understands your wishes about medical and end-of-life care. In some cases, it is appropriate to select an alternate power of attorney, in case the first person of choice is not able to carry out this position.

Once you have selected a medical power of attorney, maintain an open dialogue about medical situations that may arise and how you would handle them if you were able. The more you talk about issues like this, the more the person knows about your wishes and the more he or she will be able to honor them if and when the time comes. Issues you may want to discuss include:

  • How do you feel about feeding tubes?
  • If you are given a certain treatment, like a feeding tube or antibiotic, and it does not lead to any improvement, would you like that treatment to be stopped?
  • Do you want to be resuscitated if you stop breathing? How aggressive should CPR be if your heart stops beating?
  • What are your fears regarding potential medical treatments?
  • What circumstances may change the way you feel about certain medical treatments?

Putting it on Paper

Whether you select to write a living will, choose a power of attorney, or both, you need to make that decision legal by putting it in writing. Each state offers forms that help people do this—an attorney is not needed. You can download such forms at www.caringconnections.org, but be sure to use the correct form for your state. In most cases, you will need this form to be witnessed or notarized. Once the form is complete and notarized, make sure all parties involved in your care (doctors, hospitals, palliative care team members, family members, and your attorney) all have a copy of the form.

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