Why Health Care Directives & Living Wills Can Be Called Many Things

Whether you want to make plans for end-of-life health care decisions or you want to name someone to make health care decisions for you, you might be puzzled to see that there are a variety of legal documents with many different names related to this. The bottom line is these documents allow you to make decisions about your medical care if and when you are unable to make those decisions yourself.

Understanding Health Care Documents

In each state, you can make decisions in advance about what kinds of medical care you consent to or do not consent to. For example, you might not want to be placed on a ventilator if you were brain-dead. A health care directive is a legal document you can create that expresses your wishes about this in a legally binding way.

All states also allow you to choose someone who can make health decisions for you if you are not able to. For example, if you are in a coma, you want someone to be able to make decisions for you about what care you will receive.

Health care documents allow you to place these decisions in writing so that your family and medical team know what you want.

Types of Health Care Documents

There are two main types of health care documents: health care directives and health care proxies. Each has many names.

Health Care Directives

These indicate your choices for the care you wish to receive or not receive. Documents that fall under this category include:

• Health care directive (example from Minnesota)
• Advance directive/advance health care directive (example from Hawaii)
• Living will (example from New York)
• Declaration of desire for natural death (example from South Carolina)

Health Care Proxies

These indicate who you appoint to make health care decisions for you. Documents in this category include:

• Health care proxy (example from New York)
• Health care power of attorney/power of attorney for health care (example from Ohio)
• Durable health care power of attorney/Durable power of attorney for health care (example from Rhode Island)

Combination Documents

Some states (such as California) have documents that incorporate both your healthcare wishes and the person you choose to make decisions for you. These may be called living wills, advance directives, or any combination of the names listed above.

What Is in a Health Care Directive?

A health care directive, no matter what it is called, legally states what types of medical care you specifically choose not to receive. This could include:

• Antibiotics or antiviral medications
• Cardiopulmonary resuscitation (CPR)
• Feeding tube or IV liquids
• Kidney dialysis
• Ventilator
• Psychiatric care
• Any other medical care you do not want

You can simply say you never want these treatments, ever, or you can describe the conditions and situations in which you do not want them, such as if you are suffering from a terminal condition, persistent vegetative state, permanent unconsciousness, or other end-stage conditions. By specifically detailing the situations when the document comes into play, you can be sure you will be resuscitated or treated in all other situations.

These types of documents can also specify care you do want to receive, such as:

• Pain medication
• IV liquids for hydration
• Comfort care and other palliative treatments

And they can specify your wishes about:

• Dying at home
• An autopsy
• Donating your organs and tissue (additional forms are usually required)
• Donating your body for medical study (additional forms are usually required)

Funerals

Some people mistakenly believe that a health care directive, living will, or even their will itself can determine their funeral arrangements or direct cremation, or other body disposition. Once you have passed away, it is up to your next of kin to make those decisions. It cannot be determined in a health care directive because the authority in that document ends when you die. You can pre-plan and pre-pay for your funeral if you wish, but you must be sure to communicate the plans to your family so that they are aware of them.

Health Care Directives vs. POLST or MOLST

A POLST (physician order for life-sustaining treatment) or MOLST (medical order for life-sustaining treatment) is a document different from a health care directive. States refer to them as POLST or MOLST, depending on state law terminology.

A health care directive is a document you create yourself or with the help of an attorney. It details the care you do not wish to receive in certain circumstances or the comfort care you authorize. This document is prepared for use in the future. It's a “just in case" kind of document.

A MOLST or POLST is completed with your physician and signed by them. Once it is signed, it becomes immediately effective and is a medical order that is applicable at the moment. A MOLST or POLST addresses withholding life-sustaining treatment only, such as CPR or intubation.

Health Care Directives and DNRs

A health care directive is not a substitute for a DNR (do not resuscitate) or DNI (do not intubate) order, which must be created separately and added to your medical chart by your physician at the hospital. Often, those orders are created after the medical staff has received your healthcare directive.

DNRs and DNIs can be instituted on their own or as part of a POLST/MOLST.

A special kind of DNR is an out-of-hospital do-not-resuscitate (OOH-DNR), which is presented to EMTs who are otherwise required to attempt lifesaving treatments regardless of what your health care directive or POLST/MOLST says. Your physician signs this document.

What Is in a Health Care Proxy?

A health care proxy legally designates the person (called your proxy or attorney-in-fact) you have chosen to make medical decisions for you should you be unable to. The document names your proxy and includes their contact information. It also may allow you to name an alternate in case your first choice is not available.

This document gives your proxy the ability to make all of your medical decisions for you when you are unable to do so yourself due to being unconscious or legally mentally incompetent. It is important to note that your proxy usually can override choices you have made in your health care directive. In some states, your proxy has the power to decide whether to cremate or bury your remains.

Your proxy does not automatically have the authority to handle your finances and pay for your medical bills. You will need to execute a separate power of attorney document to give authority over financial matters if you want them to be able to do this as well.

Where to Obtain Health Care Forms

Some states create specific forms you must use for your wishes to be legally binding in that state. Other states have laws that give guidelines as to what the documents should include. It is very important that you create a document that will be legally binding in your state. You can check your state attorney general site to see if they offer forms or guidelines

You will want to talk to an attorney or work with an online legal service provider to be certain that the document you create meets your state's requirements.

You also want to be careful to execute the document according to your state's requirements. Usually, you must sign it and have it witnessed for it to be valid.

Where to Keep Your Forms

Once you complete your health care planning, you will want to make copies of the document. Keep the original in a safe place at home and provide copies to:

• All of your physicians or medical providers
• Any hospital or medical facility you receive care at
• Your proxy or attorney-in-fact
• Your immediate family

Changing Your Mind

It is your prerogative to change your mind about any decision in your medical documents at any time. You can destroy them or withdraw them from your doctors' files. You can create new ones at any time you wish. They may not remain valid if you make changes to the documents once they have been signed and witnessed, so it is always best to create new ones if you wish to change your instructions.

Health care planning documents have different names in different states. Still, whatever your state calls these documents, they are essential for planning your future care and ensuring someone you trust will be able to make decisions on your behalf.