Advance Directives for Health Care

Advance directives are documents signed by a competent person giving direction to health care providers about treatment choices in certain circumstances. As a competent adult, you understand your condition and the results your decision may have. Advance directives allow you to verbalize your wishes while you are in a position to make health care decisions. These advance directives tell your doctor what kind of care you would like to have if you become unable to make medical decisions, such as if you are in a coma. If you have not given any instructions, no one will know what you would have decided.

The Patient Self Determining Act requires many Medicare and Medicaid providers such as hospitals, nursing homes, hospice programs, home health agencies, and Health Maintenance Organizations (HMO’s) to give adult individuals, at the time of inpatient admission or enrollment, certain information about their rights under state laws governing advanced directives.

These include:
· the right to participate in and direct their own health care decisions
· the right to accept or refuse medical or surgical treatment
· the right to prepare an advance directive
· information on the provider’s policies governing the utilization of these rights.

The act also prohibits institutions from discriminating against a patient who does not have an advance directive and requires institutions to document patient information and provide ongoing community education on advance directives.

There are two types of advance directives:

· A durable power of attorney for health care which allows you to name a patient advocate or proxy to act for you and carry out your wishes.

· A living will allows you to state your wishes in writing, but does not name a patient advocate.

A living will is a written, legal document that describes the kind of medical treatments or life-sustaining treatments you would want if you were seriously or terminally ill. A living will doesn't let you select someone to make decisions for you.


A durable power of attorney (DPA) for health care identifies whom you have chosen to make health care decisions for you. It becomes active any time you are unconscious or unable to make medical decisions. A durable power of attorney for health care is a signed, dated, and witnessed legal document commonly called a “health care proxy”. This document differs from other durable powers of attorney in that it is specifically limited to health care and medically related decisions. It might be necessary to also have a durable power of attorney assigned to handle financial issues as well. A financial DPA can access your accounts to assist in payment of your bills when you lack capacity and are unable to do so.

A good advance directive describes the kind of treatment you would want depending on how sick you are. For example, the directives would describe what kind of care you want if you have an illness that you are unlikely to recover from, or if you are permanently unconscious. Advance directives usually tell your doctor that you don't want certain kinds of treatment. An example would be a do not resuscitate (DNR) order. Advance Directives can also say that you want a certain treatment no matter how ill you are. An example would be to continue feedings.

Advance directives can take many forms. Laws about advance directives are different in each state. You should be aware of the laws in your state.

Any person 18 years of age or older can prepare an advance directive which allows you to make your preferences about medical care known before you're faced with a serious injury or illness. People who are seriously or terminally ill are more likely to have an advance directive injury or illness to express their wishes and spare their loved ones the stress of making decisions about their care when they are dying. Even if you are in good health an accident or serious illness can occur suddenly and if you already have a signed advance directive, your wishes are more likely to be followed.

Ask your doctor, lawyer or state representative about the law in your state.

Additional information and forms can be obtained from:

AARP Advance Directive Information

601 E Street NW Washington, DC 20049 1

888-OUR-AARP

email: http://www.aarp.org/bulletin/yourhealth/resources_wills.html


U.S. Living Wills Registry

523 Westfield Ave., P.O. Box 2789 Westfield, NJ 07091-2789

1-800-LIV-WILL

email: http://www.uslivingwillregistry.com/


http://www.caringinfo.org/stateaddownload


or call your local health department or state department on aging to get a form.

Living wills and DPAs are legal in most states. Even if they aren't officially recognized by the law in your state, they can still guide your loved ones and doctor if you are unable to make decisions about your medical care.

Advance directives and living wills do not have to be complicated legal documents. They can be short, simple statements about what you want done or not done if you can't speak for yourself. Remember, anything you write by yourself or with a computer software package should follow your state laws. You may also want to have what you have written reviewed by your doctor or a lawyer to make sure your directives are understood exactly as you intended. When you are satisfied with your directives, the orders should be notarized if possible, and copies should be given to your family and your doctor.

You may change or cancel your advance directive at any time, as long as you are still able to think rationally and communicate your wishes in a clear manner. Any changes must be made, signed and notarized according to the laws in your state. Make sure that your doctor and any family members who knew about your directives are also aware that you have changed them.

It is a good idea to review your advance directive each year to be sure it still says how you want to be treated and names an advocate you trust.