No matter your age, it’s always a good idea to create a plan for your healthcare future. Unfortunately, life is precarious, and you never know when something could happen that may render you incapable of making decisions for yourself. Try to think about an advance directive as an investment in your autonomy, rather than a fear-based affair. This article will address many of the considerations you should make around these crucial decisions.
What is an Advance Directive?
Advance directives are documents that let people know what medical decisions you want to make if you can’t speak for yourself due to illness or injury. There are two types of advance directives:
Health care proxy. This is a document that names the person who will make your medical decisions if you can’t. It’s also called a durable power of attorney. Before this can be used for medical situations, a physician must certify that you cannot make decisions. Next, the person you nominated will consult with your medical team and make decisions based on your guidelines. This person should be someone who knows you well and you trust. They should also be someone who will ask the right questions and fully advocate for you. Try to discuss all possible scenarios with them thoroughly. You may also want to nominate a second person in case the first is unavailable.
A living will. This describes what you want to happen if your life is threatened, including decisions about whether or not you would like to be put on breathing machines or get dialysis, tube feeding, or organ and tissue donations. Generally, it will outline when to prolong and when to end life. However, before it’s used, at least two healthcare providers will have to confirm that you are unable to make medical decisions and that your health condition qualifies as a terminal illness or state of permanent unconsciousness.
You can get official advance directives from:
- Your medical care provider.
- Your attorney.
- A local agency for aging.
- Your state health department.
What is a Physician Order for Life-Sustaining Treatment?
A physician order for life-sustaining treatment (POLST) isn’t technically an advance directive but functions similarly. It’s typically created for chronically ill people, addressing emergencies in how and where you want treatment, and how you want to stay comfortable in an emergency.
A physician will sign a POLST. People like EMTs and paramedics are not allowed to use advance directives, but can use POLST forms. If you don’t have a POLST, they are legally required to keep you alive however possible.
What are Do Not Resuscitate Orders?
Resuscitation is when a medical professional tries to restart your breathing or heartbeat using modern medical technologies. A do not resuscitate order (DNR) is a note in your medical file to let medical professionals not resuscitate you. In a hospital, you’ll have to ask your doctor to create a new DNR every time you are admitted.
Depending on the state, you usually fill out a form if you want a DNR. From there, you can either have a card in your wallet, a bracelet, or other document to let any medical professionals know you do not want to be resuscitated. If you do not have a visible DNR, they will try to revive you.
Think About What You Value
A helpful place to start when considering your advance directives is possible medical care situations based on your current health. Schedule an appointment with your doctor where you can candidly discuss you and your family’s health history and how that can affect you in the future.
For example, if you are at a higher risk of a stroke, you and your doctor can discuss your possibility of having a stroke and what types of decisions you might face. On the other hand, suppose there aren’t any glaringly apparent potential health outcomes based on your current situation. In that case, your family health history can be a helpful place to start.
Some other questions that may help you begin to think about your advance directives are:
- Do you value living longer or having a higher quality of life?
- Would you be in favor of having life-saving surgery if your heart stops?
- Are you willing to live with severe mental impediments?
- If you were placed on a ventilator in a state of permanent unconsciousness, how long would you want that to continue?
- Do you want to get liquid or food through a tube or IV if you can’t eat or drink?
- Are you comfortable having your organs donated if you die?
- Do you want to get treatment for pain, nausea, or other symptoms?
- What kind of palliative or comfort care do you generally want?
Our values are so personal. Even if you are incredibly close to someone, they might not understand your stance on something as unique as to how long or how you want to live. Your values are also likely to change as you get older.
Additionally, the laws for these things vary greatly from state to state, so make sure to check with your local regulations for advance directive options.