Questions & Answers: Advance Directives and End of Life Decisions
When will my advance directives go into effect?
Your advance directives become legally valid as soon as you sign them in
front of the required witnesses. However, they normally do not go into effect
unless you are unable to make your own decisions and each state establishes its
own guidelines for when advance directives become operative. The rules may
differ for living wills and medical powers of attorney, as described below.
Living will. In most states, before your living will can guide
medical decision making, two physicians must certify that you are unable to
make medical decisions and that you are in the medical condition specified in
the state's living will law (such as "terminal illness" or
"permanent unconsciousness"). Other requirements also may apply,
depending upon the state.
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Medical power of attorney. Most medical powers of attorney go into
effect when your physician concludes that you are unable to make your own
medical decisions. If you regain the ability to make decisions, your agent
cannot continue to act for you. Many states have additional requirements that
apply only to decisions about life-sustaining medical treatments. For example,
before your agent can refuse a life-sustaining treatment on your behalf, a
second physician may have to confirm your doctor's assessment that you are
incapable of making treatment decisions.
Your state specific advance directive provided by The National Hospice and
Palliative Care Organization explains when the documents go into effect under
your state's laws.
Will my advance directives be honored if I am in an accident or experience a medical crisis at home and emergency technicians are called?
In these emergency situations, unless you are able to speak for yourself,
your consent to treatment is presumed. Once emergency personnel have been
called, they are obligated to do what is necessary to stabilize a patient for
transfer to a hospital, both from accident sites and from a home or other
facility. After a physician fully evaluates the person's condition and
determines the underlying conditions, advance directives can be implemented if
Emergency medical technicians cannot honor living wills or medical powers of
attorney. However, in many localities, the specific crisis of cardiac
arrest/respiratory arrest is addressed by a document called a
"Non-hospital Do-Not-Resuscitate Order." Individuals with
underlying conditions that would make resuscitation unwarranted under any
circumstances can carry a special "do-not-resuscitate" (DNR) order
signed by a doctor and in some states can wear a special bracelet or other
indicator that such a signed order exists.
These non-hospital DNR orders instruct emergency personnel not to perform
cardiopulmonary resuscitation (CPR). These orders apply to situations in which
the person's heart has stopped beating or breathing has stopped. For all other
conditions, emergency medical technicians are still required to treat and
transport the patient to the nearest hospital for evaluation by a physician. If
you wish to find out whether non-hospital DNR orders are available in your
locality, contact your local emergency medical service or department of
WebMD Medical Reference from the National Hospice and Palliative Care Organization