Advance Directives

Types of Advance Directives

Living Will

This is a document used for people to state whether or not they would like to receive certain types of medical care if they become unable to speak for themselves. The most common types of care addressed by a living will are:

• The use of machines to keep you alive. Examples include dialysis machines and ventilators (also called respirators).
• “Do not resuscitate” (DNR) orders. These instruct the health care team not to use cardiopulmonary resuscitation (CPR) if your breathing or heartbeat stops.
• Tube feeding
• Withholding food and fluids
• Organ and tissue donation

Medical Power of Attorney

This is a document that allows people to name another person to make decisions about their medical care if they are unable to make these decisions for themselves. (It is also called a health care proxy or durable power of attorney for health care.) People often appoint someone they know well and trust to carry out their wishes. This person may be called a health care agent, surrogate, or proxy.

Why Advance Directives Are Important

Filling out advance directives gives people control over their health care. Choices about end-of-life care can be hard to make even when people are healthy. But if they are already seriously ill, such decisions can seem overwhelming. Some cancer patients want to try every drug or treatment in the hope that something will be effective. Others will choose to stop treatment. Although patients may turn to family and friends for advice, ultimately it is the patient’s decision.

It’s important to keep in mind that if a day comes where you choose not to receive or to stop treatment to control your disease, medical care to promote your well-being (palliative care) continues. This type of care includes treatment to manage pain and other physical symptoms, as well as support for psychosocial and spiritual needs. You have the right to make your own decisions about treatment. Filling out advance directives gives you a way to be in control.

When to Fill Out Advance Directives

Ideally, these documents should be completed when you’re healthy. Yet many people connect filling out advance directives to making decisions near the end of life. But you don’t need to wait until being diagnosed with a serious illness to think about your wishes for care. In fact, making these choices when you’re healthy can reduce the burden on you and your loved ones later on. Talking about these issues ensures that when the time comes, you will face the end of your life with dignity and with treatment that reflects your values.

Talk to your doctor, nurse, or social worker for advice or help with filling out advance directives. Most health care facilities have someone who can help. As you prepare your advance directives, you should talk about your decisions with family members and loved ones and explain the reasons behind your choices.

It's hard to talk about these issues. But the benefits of talking to the people close to you about the kind of care you want are:

• Your wishes are known and can be followed.
• It often comforts family members to know what you want.
• It saves family members from having to bring up the subject themselves.
• You may also gain peace of mind. You are making the choices for yourself instead of leaving them to your loved ones.
• It can help you and your loved ones worry less about the future and live each day to the fullest.

If talking with your family and other loved ones is too hard, consider having a family meeting and invite a social worker or member of the faith community to guide the discussion.

Reviewing and Signing Your Advance Directives

Once your advance directives have been completed, the next steps are:

• Review them with a member of your health care team or other health care professional for accuracy before signing. Most states require a witness to be present at the signing of the documents.
• Provide copies to your doctor, hospital, and family members after you sign them.
• Store copies in a safe, accessible place.
• Consider keeping a card in your wallet with a written statement declaring you have a living will and medical power of attorney and describing where the documents can be found.

Some organizations will store advance directives and make them available on the patient’s behalf. Contact the National Hospice and Palliative Care Organization for more information about companies that provide this service.

Changing Your Advance Directives

Even after advance directives have been signed, you can change your mind at any time. As a matter of fact, the process of discussing advance directives should be ongoing, rather than taking place just once. This way you can review the documents from time to time and modify them if your situation or wishes change.

To update your document, you should talk to your health care providers and loved ones about the new decisions you would like to make. When new advance directives have been signed, the old ones should be destroyed.

Advance Directives and State Laws

Each state has its own laws regarding advance directives. Therefore, special care should be taken to follow the laws of the state where you live or are being treated. A living will or medical power of attorney that is accepted in one state may not be accepted in another state. State-specific advance directives can be downloaded from the National Hospice and Palliative Care Organization.

More Information about Advance Directives

There are a number of organizations that can answer questions and give you more information about advance directives. Two well-known ones are:

Aging With Dignity
Aging with Dignity is a national nonprofit organization that worked with the American Bar Association to develop an easy-to-read living will called Five Wishes.  This document is legal in 42 states and the District of Columbia, and is available in 26 languages, including Spanish and Braille. The organization has also created an advance care planning guide for adolescents and young adults called Voicing My Choices. Both these, and other resources, can be accessed online or ordered in hard copy format.
http://www.agingwithdignity.org
1–888–594–7437 (1-888-5WISHES)
1-850–681–2010

National Hospice and Palliative Care Organization
The National Hospice and Palliative Care Organization (NHPCO) represents programs and professionals that provide hospice and palliative care in the United States. Caring Connections is a national consumer and community engagement program of NHPCO that works to improve care at the end of life. Caring Connections provides a toll-free number, website, and a wide range of free materials about end-of-life care (such as hospice and palliative care information, advance care planning, and caregiving). Caring Connections provides free advance directives with instructions for each state. Some Spanish-language publications are available, and staff can answer calls in Spanish.

1–800–658–8898 (helpline)
1–877–658–8896 (multilingual line)
caringinfo@nhpco.org
http://www.caringinfo.org