Advance Directives

shutterstock_177864101

A Living Will and a Durable Power of Attorney are two types of advance directives

Advance directives are legal documents written while an individual is still able to make decisions about their own healthcare. The two most common types of advance directives are living will and durable power of attorney for healthcare (American Cancer Society [ACA], 2015a; American Bar Association [ABA], n.d.).

Advance directives inform healthcare providers what they should and should not do if the individual becomes incapacitated or incompetent (ACA, 2015b). In other words, the document speaks for the individual when he or she cannot speak for themselves.  Advance directives allow one to make end-of-life care decisions ahead of time.

All fifty states allow advance directives (ABA, n.d.). However, details regarding advance directives can vary from state-to-state (ACA, 2015a). Some states recognize spoken (oral) advance directives as legal (ACA, 2015a). No matter what type of advance directive an individual chooses, no one will be able to control his or her money or other property based on the advance directive. The individual can also change or cancel the directive at any time (ACA, 2015b).

Did You Know!
The most common types of advance directives are the living will and the durable power of attorney for health care

The Living Will

A living will is a legal document that informs healthcare providers what they can and cannot do in certain medical circumstances (ABA, n.d.). For example, living wills may state exactly what types of life-sustaining treatments the individual will accept (ACA, 2015b). Life-sustaining treatments could include medical machines that prolong life but do not cure the disease. Examples include heart-lung machines (to pump the blood), ventilators (a breathing machine), and feeding tubes (ABA, n.d.). Living wills may also include the individuals desires regarding pain management or organ donation. However, living wills do not determine the person’s routine medical care.

A living will becomes active only when the individual is unable to express his or her wishes about their health care treatment. An individual can update or cancel a living will anytime they wish, as long as they are competent.

Durable Power of Attorney for Healthcare

shutterstock_134020133

In her Durable Medical Power of Attorney for Healthcare, Mrs. Hamid has chosen her son to be her medical decisions in case she is not able to do so herself

Durable Power of Attorney for Healthcare is also known as “health care proxy,” “health care surrogate,” or “durable medical power of attorney.” A durable power of attorney for healthcare names a trusted person to make healthcare decisions for the individual if they become incapacitated or incompetent (ACA, 2015b).

Usually, a durable power of attorney is not active until two physicians certify that 1) the individual is unable to make medical decisions and 2) the individual has the medical condition defined in the living will law (e.g., terminal illness or permanent unconsciousness) (ABA, n.d.; National Hospice and Palliative Care Organization, n.d.).

An individual can update or cancel a durable power of attorney for healthcare anytime they wish, as long as they are competent.

General Recommendations

  • Learn about options for end-of-life services and care
  • Implement plans to ensure the wishes of your loved ones are honored
  • Voice your decisions to family, friends and health care providers. Let them know about your advance directive if you have one
  • Before you appoint the person to make decisions on your behalf, make sure they understand your wishes. Is there a religious view that may prevent your health care proxy from carrying out your wishes?

Aging with Dignity

shutterstock_276856736

5 Wishes is a living will that allows one to discuss their personal, spiritual and emotional needs and wishes

Aging with Dignity is a private, non-profit organization with a mission to safeguard the human dignity of aging people who face serious illness (Aging with Dignity, n.d.a). Aging with Dignity provides the Five Wishes document (Aging with Dignity, n.d.b).  A living will allows one to discuss their personal, spiritual and emotional needs and wishes.  It meets the legal requirements for an advance directive in 42 states and the District of Columbia (Aging with Dignity, n.d.b). The Five Wishes include:

  • Wish 1: The Person I Want to Make Care Decisions for Me When I Can’t,
  • Wish 2: The Kind of Medical Treatment I Want or Don’t Want,
  • Wish 3: How Comfortable I Want to Be,
  • Wish 4: How I Want People to Treat Me, and
  • Wish 5: What I Want My Loved Ones to Know (Aging with Dignity, n.d.b).

References

Aging with Dignity. (n.d.a). History and Mission. Retrieved on January 1, 2017 from https://www.agingwithdignity.org/about-us

Aging with Dignity. (n.d.b). Five Wishes. Retrieved on January 1, 2017 from https://agingwithdignity.org/docs/default-source/default-document-library/product-samples/fwsample.pdf?sfvrsn=2

American Bar Association. (n.d.). Living wills, health care Proxies, & advance health care directives. Retrieved from http://www.americanbar.org/groups/real_property_trust_estate/resources/estate_planning/living_wills_health_care_proxies_advance_health_care_directives.html

American Cancer Society. (June 24, 2015a). Types of advance directives. Retrieved from http://www.cancer.org/treatment/findingandpayingfortreatment/understandingfinancialandlegalmatters/advancedirectives/advance-directives-types-of-advance-health-care-directives

American Cancer Society. (June 24, 2015b). What is an advance directive? Retrieved from http://www.cancer.org/treatment/findingandpayingfortreatment/understandingfinancialandlegalmatters/advancedirectives/advance-directives-what-is-an-advance-health-care-directive

National Hospice and Palliative Care Organization. (n.d.). What are advance directives? Retrieved from http://www.caringinfo.org/i4a/pages/index.cfm?pageid=3285


Last updated: March 13, 2017 at 15:45 pm by
I. M. Abumaria, AGPCNP-BC
Version 1.00