At some point in their lives, usually because of illness, many people will lose the ability to make medical decisions or communicate what they want from their healthcare. The legal documents that allow you to spell out your healthcare decisions ahead of time – so you continue to get the care you want and avoid treatments you do not want – are called advance directives (also known as advance care plans).
If you lose the ability to make decisions, someone will have to make decisions for you. The person you choose to make those decisions for you is known as a surrogate. Your surrogate should try to honor any wishes you discussed with them while you were still capable of making decisions. Their job is to make the decisions you would make for yourself if you were still able to do so. That’s why creating an advance directive by thinking about your priorities, discussing them with a surrogate, and writing them on a legal document is so important.
Advance directives go into effect only when you lose the ability to make decisions. (Only healthcare professionals can determine if you do or don’t have the ability to make decisions.)
There are two common types of advance directives that express your wishes about the health care you desire:
Living wills
Durable power of attorney for healthcare
Different states may have different names for durable power of attorney for healthcare, such as healthcare proxy or healthcare declaration.
A specific and common example of an advance directive is a “do not resuscitate” order (or DNR), which guides care only if your heart stops beating (cardiac arrest) or you are no longer breathing. Someone who chooses a DNR order may or may not choose to go without other life-sustaining treatments, including hospital or intensive care.
Whenever possible, your healthcare providers should respect the informed choices that you have expressed while you were still capable of making decisions. Following these advance directives demonstrates respect for you as an individual. It is a legal and ethical obligation. Advance directives can be stopped or changed orally or in writing by you at any time, as long as you maintain the capacity to make decisions.
Think about what treatment you would or would not want if you were critically ill or no longer able to communicate your wishes. One way to do this is to think about people you know who have been in that situation. They may be family members, friends, acquaintances, or famous people. What did you think of their treatment? Would you want that for yourself?
Discuss your wishes with your surrogate, relatives and other people close to you and your healthcare providers while you are still able. It is never too early to have these conversations.
Document your wishes. Your advance directives should be written down carefully so that your wishes are specific, clear, and available later if needed. They should be reevaluated and revised whenever your medical condition changes.
Advance directives help patients and their families. It has been found that advance care planning helps to allow people to have improved satisfaction with their quality of care, die in their preferred place, receive less intensive treatments at the end of life, and reduce hospitalizations at the end of life. It also results in lower stress, depression and anxiety in the surviving relatives of a person who has died.
Throughout the United States, there are laws or legal opinions that authorize living wills. Generally, these laws allow you to direct healthcare providers to withhold or withdraw treatment that is keeping you alive if you become terminally ill and are no longer able to make decisions.
