Some types of health conditions, like Alzheimer's disease, mean that at some point you might not be able to make your own decisions about the health care you get. In these cases, it helps to have legal documents with instructions on the kind of treatment you want. These documents are called advance directives.
There are two types of advance directives:
- Living will
- Healthcare power of attorney
States have different laws about advance directives and how they’re applied, so check with a lawyer to learn the rules for where you live.
This legal document lets you specify whether or not you want doctors to use life support procedures if you become permanently unconscious or can no longer make informed decisions.
It lets doctors know if they should use or withhold any treatment that might prolong your life, like putting you on a respirator if you stop breathing. In some states, life support includes giving food and water when a person is in an irreversible coma.
A living will goes into effect only when two doctors decide that you’re either in a coma and won’t recover or you have a terminal illness and can’t make decisions for yourself.
States have different names for a living will, including “medical directive,” “healthcare declaration,” “physician instruction,” and “instruction directive.”
Healthcare Power of Attorney
The “durable power of attorney for health care,” or “health care proxy,” is a document that lets you state who should make health care decisions for you if you’re no longer able to make them yourself. Your inability to make your own decisions may be temporary because of an accident or permanent because of a disease. The person you name is called the agent or attorney-in-fact.
The document lets you name an agent and specify the treatments you want or don’t want to have. Unlike a living will, you don’t have to be terminally ill or in a coma for a power of attorney to take effect. It applies anytime you lose your ability to make health care decisions.
You can name anyone over age 18 as your agent, except for your doctor or their employees. The agent has no legal obligation to serve and isn’t responsible for the financial costs of your treatment. Only one agent can serve at a time, but you can name other agents to fill in if your first choice isn’t able or willing to fill the role.
How Do I Make an Advance Directive?
Anyone over age 18 who is of sound mind can make one. You can get a form from your doctor or simply write down your wishes. Many state health departments have sample documents online that you can download. If you’d like help from a lawyer, that’s an option, too. For a directive to be legal, you need to have two adult witnesses or get it notarized.
You can cancel an advance directive at any time. Ways to do that include:
- Tear up the document.
- Say aloud to witnesses that you want to cancel it.
- Put your wishes in writing.
Many hospitals and clinics will ask you or your family if you have an advance directive when you’re admitted for treatment. It’s also noted in your medical chart. At the same time, doctors or nurses who witness you canceling a directive will also note it in your chart.
Do Not Resuscitate (DNR) Orders
Advance directives aren’t “do not resuscitate orders.” Doctors write these orders to reflect a person’s wishes not to have CPR if they are not breathing or if their heart stops, or because the person wouldn’t benefit from these life-saving measures. Even if you have an advance directive, you may want treatment that can save you from a treatable problem, like pneumonia or a urinary tract infection.
Beyond the Paperwork
Talk with your family and your doctor about your wishes for treatment and end-of-life care, too.
Make sure you understand your options and how to ensure they’ll be followed when it’s time.