How To Create an Advance Directive

While it’s common to encourage elderly parents to have their “papers in order” in case of their demise, we seldom have our own last will and testament written. Too many people suffer catastrophic injuries without a healthcare directive in place, leaving their family to guess at what they wanted for medical treatment.

Everyone should have an advance healthcare directive in place. You can prepare this document at home with your family members, and doing so won’t require an attorney. Advance directives clearly state your healthcare wishes if you have a medical emergency and cannot speak for yourself.

You don’t need to wait until you’re terminally ill, old, retired, or have a medical condition to create your advance directive. This article explains what an advance directive is and how to make your own.

What Is an Advance Directive?

An advance directive is a document or set of documents that speaks for you when you can’t speak for yourself. Advance directives can include end-of-life decisions, instructions for who can make medical decisions on your behalf, and preferences for artificial life support.

Legal Requirements for Advance Directives

Although anyone can have an advance directive, it must follow your state laws to be legally binding. Common requirements include:

• Being over the age of 18
• Able to understand the nature of the directive and when it applies
• Some states require the document to be notarized or witnessed

Most states have a specific Advance Directive form you can use. These are available at your state attorney general or health department website.

Types of Advance Directives

An advance directive lets you state your medical treatment wishes. There are three basic types of advance directives.

Living Wills

A living will is a legal document that comes into effect when you lack decision-making capacity due to a terminal condition, a persistent vegetative state, or an end-stage medical condition. A living will is not the same thing as a “last will and testament.” Your living will, or healthcare directive, gives the doctor instructions for what to do if you’re unconscious or incapacitated and can’t make decisions on your own. Living wills give your doctor instructions about:

• The use of “heroic measures” such as the use of feeding tubes or ventilators
• Resuscitation orders, including intubation and CPR
• Organ donation

Living wills also give doctors and family members your end-of-life care instructions. If you don’t want life-sustaining treatment after a doctor declares you brain-dead or in a permanent vegetative state, a living will can leave instructions on termination of nutrition and hydration.

Your state may have laws regarding what a living will must include, such as witness signatures or notarization. You can find forms to create a living will online.

Power of Attorney for Healthcare

A power of attorney for healthcare, or healthcare proxy, allows you to decide on future healthcare needs. In this aspect, it is similar to a living will. A healthcare power of attorney also lets you choose a caregiver, friend, or family member to make medical decisions on your behalf. This person is your healthcare proxy, agent, or surrogate.

A healthcare surrogate can only make decisions about your medical care. You can give other individuals powers of attorney over your finances or business decisions. A medical power of attorney begins if you are unconscious or medically incapacitated, and usually ends if you become able to make medical decisions for yourself again. For instance, you may want someone to have a medical power of attorney before you go in for surgery, and then have it end when you wake up from anesthesia.

Most states have specific power of attorney forms you need to use when granting these legal powers. Verify that you’re using the correct form before completing and signing the document. Your surrogate has only the powers designated on the form. Discuss what you’re delegating with your prospective healthcare agent before signing. You want someone who’ll carry out all your wishes, even if they disagree with them.

Do Not Resuscitate (DNR) and Related Orders

Do Not Resuscitate orders are advance requests forbidding cardiopulmonary resuscitation (CPR) or advanced cardiac life support (ACLS) if your heart stops. DNRs are essential for those who don’t want to have this potentially life-saving measure. Without such a directive, healthcare professionals will attempt to revive non-responsive patients. A DNR applies only to CPR. A DNR order won’t prevent other life-saving measures.

If you don’t wish to be intubated (having a tracheal or nasal airway placed to assist your breathing), you need a Do Not Intubate (DNI) order. A DNI order prevents you from being placed on a ventilator or other breathing assistance if you stop breathing.

Patients in long-term care, nursing homes, and assisted living facilities may want a Do Not Hospitalize (DNH) order. These directives instruct the facilities and their families that in the event of a life-threatening emergency, they don’t want to be transported to a hospital for life-prolonging treatment. This usually results in palliative care at the facility.

In many states, these requests can be combined into a single order called Physician Order for Life-Sustaining Treatment (POLST). Other states have a Medical Order for Life-Sustaining Treatment (MOLST). Check with your state about which forms they use, or ask your doctor.

You can find DNR, DNI, and DNH forms online or at your doctor’s office. When you complete the forms, you’ll need a licensed healthcare provider‘s signature. Give a copy to your healthcare provider and put another on your refrigerator door. First responders look for documents on refrigerators and will follow any instructions they find there.

Get Legal Help From a Healthcare Attorney

In most cases, you don’t need legal assistance to complete these forms. If you have any doubts about terminology or following state laws, consider speaking with a healthcare attorney. It’s a good idea to meet with a lawyer in situations like these:

• You’re uncomfortable giving another person the right to make healthcare decisions when you cannot be consulted
• Your family isn’t in agreement with your end-of-life planning
• You want to ensure your living will, advance care planning, or other instructions are followed
• You’re unsure about your state’s requirements

Share your advance directive with your designated agent and healthcare team so people will understand your wishes. Meeting with a healthcare attorney can ensure your important medical preferences are understood when you’re incapacitated.