Advance Healthcare Directives: What to Know

Imagine finding yourself incapacitated and unable to speak with family members or doctors. How can you ensure your wishes will be met? This is often one of the many question marks that pop up during a medical emergency or at the end of life. Creating an advance healthcare directive helps solve this issue and ensures your best interest stays intact if you can’t communicate.

In this article, we’ll explain what medical directives are, as well as break down the different types. You’ll also learn about their benefits and how to approach creating one.

What Are Advance Healthcare Directives?

An advance healthcare directive is a legally binding document that outlines what healthcare actions should take place when you can’t speak up for yourself or agree on medical decisions. This is often the case during end-of-life or emergency scenarios.

Having a directive in place for your medical care ensures your wishes become a reality when you’re no longer able to express them. This can help relieve some of the stress on family members or other individuals who carry the immense weight of holding power of attorney (POA).

Types of Healthcare Directives

While they all deal with your medical care in serious health events, not all advance directives are the same. There are various types, each with different functions and reasons to have them. Below are the most widely used:

Living Wills

This is one of the most common types of directives. It explicitly lays out what should happen when a health emergency or terminal illness incapacitates you and stops your ability to communicate. This might include deciding whether to use life-sustaining treatments, including AEDs, medications, intubation, or even surgery.

Durable Power of Attorney for Healthcare

Also known as a healthcare proxy, this allows you to designate one or more people, known as an agent or attorney-in-fact, to hold decision-making power over your medical care when you’re incapacitated. Individuals with this power will be able to confer with doctors and nurses and decide which treatments you receive and those you won’t. They must act as a fiduciary and follow your instructions within the POA document. Since these are durable, they last for the duration of your incapacitation.

Do Not Resuscitate (DNR) Order

DNR orders are when you tell your doctor you don’t want them to save you in a life-threatening situation. This means they won’t perform life-saving measures such as restarting your heart, using medication, or basic CPR. People will often tell their doctor to enact a DNR order if they believe they’re in a position where their condition will only get worse as time goes on. If you’re unable to communicate and have stipulated it in your POA document, an attorney-in-fact can ask your doctor to issue a DNR order.

Mental Health Advanced Directive

This directive specifies hospitalization and treatment preferences if you have a mental health crisis and can’t make decisions on your behalf. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), it will ideally lay out the treatments you wish to receive, including therapies and medication, as well as specify a trusted person who will act in your best interest and communicate for you.

Organ and Tissue Donation

We’ve all undoubtedly seen driver’s licenses with a little heart and the words, “Organ Donor,” right next to it. These are people who have registered to donate their organs and tissues to the medical field, including to other patients, after they pass away. Registering with your state is the most common way to do this. And, while organ donation isn’t technically a directive, you can add it to a living will or POA document.

Five Wishes

Established by the non-profit organization, Aging with Dignity, Five Wishes is a living will advance directive that aims to recognize the person behind the document. To do this, it includes five main wishes designed to get to the heart of your desires, both medical and personal. Based on a sample document from the organization, the five wishes are as follows:

1. “The person I want to make care decisions for me when I can’t.”
2. “The kind of medical treatment I want or don’t want.”
3. “How comfortable I want to be.”
4. “How I want people to treat me.”
5. “What I want my loved ones to know.”

Physician Orders for Life-Sustaining Treatment (POLST)

A POLST is a form containing instructions for another medical care provider on how to apply life-sustaining treatments. Since people who experience serious or life-threatening circumstances might find themselves under the care of different providers over a short period, these forms act as a mouthpiece when they can’t speak up. They’re often signed by your doctor and convey information such as what treatment you want and whether you’d like to be resuscitated.

Advance Healthcare Directive Benefits

Creating an advance healthcare directive is often essential in putting together a complete estate plan. Medical emergencies, especially later in life, are often unavoidable. Therefore, it makes sense to have a plan in place if you can’t speak up for yourself and tell people what you want to happen regarding your health and well-being.

In many cases, having a medical directive also takes some of the burden off the shoulders of family members and friends. It can be extremely stressful to make critical and costly medical decisions on your behalf. So, having some of these big decisions already made ahead of a crisis can reduce guilt and friction among family members and other important stakeholders in your life.

How to Create an Advance Healthcare Directive

Creating a healthcare directive is generally a straightforward process. In the most basic sense, it must be a written document that states your wishes and is signed by you and, if applicable, whomever you name as an agent or attorney-in-fact.

However, it’s important to keep in mind that laws can vary by state. For example, some states may require the presence of a witness or a notary while you sign your document while others may not. For reference, AARP provides a comprehensive list of directive forms by state. They include instructions on how to set one up and the regulations you’ll need to follow.

Here are five things to consider before and while making a directive:

• Your health decisions. As soon as you create the document, and assuming you don’t make any changes, it will act as your voice if you become incapacitated. Think carefully about what you want and the treatment you would or wouldn’t want to receive. For more clarity, it’s a good idea to speak with your provider.
• Hiring a professional. An estate planner or attorney may be able to help you figure out how to create a directive and follow your state’s laws while doing so.
• Who you trust to make decisions. In some cases, such as with a POA, you’ll need to select someone (e.g., a relative, friend, or even a lawyer) to be a decision-maker on your health matters. Think about who you trust, as well as who is the most capable to act as your agent.
• Talking to your doctor. As we briefly touched upon in the first bullet, a doctor can be an invaluable resource when setting up a directive. Using their expertise, they can answer any questions you have, tell you about treatments, and help you learn about how directives work when they go into effect.
• Be specific. When you name your preferences, you must be as specific as possible when stipulating treatments or decisions. Since you won’t be able to communicate, there’s no such thing as too much information.

Frequently Asked Questions

When should I file a healthcare directive?

Many people think of these as something you need towards the end of your life. But it’s hard to predict when you might need one. Unfortunately, you may need a directive sooner rather than later. A medical event, such as a car accident or illness, could leave you unconscious and unable to communicate your wishes. With these documents on file, no one needs to guess what your wishes are and no one else must make these important decisions on-the-fly.

What if I change my mind? Can I make changes to my directives?

You can make changes to your healthcare directives as long as you’re conscious and able to communicate your wishes. It’s also critical that you notify anybody named in the document of all amendments.

Do healthcare directives need to be notarized or have witnesses?

In some cases, yes. Some states require you to have witnesses sign the document as you do so. Other states may mandate notarization of healthcare directive documents. We recommend consulting your state’s laws or talking to a legal professional to get a more complete handle on how to ensure your directive complies.