This overview is a sample of the type of information available to you at Griffin Hospital's Community Health Resource Center. It is not intended to replace your physician's instructions in the management of your health problems, but to better inform you about a particular illness and alert you to the availability of other materials. If you have a question about any piece of information presented in theses fact sheets, please call your physician, or stop by the Community Health Resource Center at your convenience.
Advance Directives are oral and written instructions that outline which life-saving or life-sustaining measures you do or do not want to be used if you become critically ill or near death. You have the right to accept or refuse any or all medical treatment. However, because of illness or injury you may be unable to speak for yourself to approve or refuse medical treatment. Without instructions from you, medical personnel will automatically perform whatever measures are available to them in order to keep you alive. These measures may include an attempt to restart your heart or assist your breathing.
In a written form, your Advance Directives are legal documents that become part of your medical record and are to be followed in the event you are unable to communicate. The documents should be placed in your chart at your doctor's office and copies should also be given to others who might need them. This can include the home health care staff who is providing services to you, the hospital where you have been admitted, a close family member, your lawyer (attorney), the person who holds your health care power of attorney, and your financial representative (or trust officer).
In addition to putting your Advance Directives in writing, it is also important that you and your doctor(s) have a full discussion about what you want as your end-of-life care. Make sure you let him or her know how you feel and provide copies of the document for your medical files in the doctor's office (if you routinely see several doctors, it is a good idea to have your directives on file in their offices too).
There are two main types of Advance Directives which may be combined into one document as a single “Advance Directive.”
One type is called a Living Will. A Living Will gives specific instructions for end-of-life care. It is used only when you are unable to make those decisions for yourself, such as when you are unconscious or not able to express your consent. Medical procedures covered in a Living Will can include:
You may choose to specify any or all of these procedures in your Living Will. You may also specify in which situations you do want or do not want certain procedures done and when to stop them. You can also be specific about whether you prefer your end-of-life (hospice) care to be at home or in a special type of nursing home.
The other type of Advance Directive is a Durable Power of Attorney for Health Care (DPOAHC). This document is also called a Health Care Power of Attorney; Medical Power of Attorney; Health Care Proxy; or Health Care Surrogate. In this document you name someone you trust as your “agent” to make medical decisions for you, if you become unable to do so. An alternative agent can also be named to carry out your wishes if the first agent is not available. Make sure that the person(s) you name as your agent(s) understands what is expected of them and that they clearly understand what you want. If there is no one person that you trust to become your agent for health care power of attorney, be sure that your written Living Will represents your wishes as completely as possible.
The medical community assumes that everyone wants to be revived (resuscitated) if they are dying. Physicians, emergency personnel, and other health care professionals are legally obligated to do CPR on any person whose heart stops or who stops breathing regardless of the circumstances unless there are specific instructions not to do so. In some cases CPR is done even though the person does not have a good chance for long-term survival. The outcome of CPR can vary depending on an individual's condition, the length of time that has passed before CPR was started, and the underlying medical condition or accident. Sometimes people with life-threatening diseases decide that they do not want to have CPR started when their heart or lungs begin to fail. Preparing Advance Directives helps you to make sure you will be treated according to your wishes.
Anyone who is over 18 years of age and mentally competent can make Advance Directives. A parent or legal guardian makes medical decisions for children under 18 years of age. People who are declared mentally incompetent will have their medical decisions made for the by a court-designated guardian or conservator, often a family member.
Health care organizations are required by law to ask you if you have Advance Directives each time you are admitted to a hospital, nursing home, or home care agency. They are also required to provide information on Advance Directives and how to prepare them. If you have Advance Directives, you should provide a copy for your medical records at each admission. If you cannot be asked directly (due to illness or injury), your family, doctor's office, or legal representative (e.g. your medical power of attorney or attorney) will be asked for your Advance Directives. Admission to a hospital, nursing home, or home health agency may be a good time to consider making Advanced Directives and to get information about how to prepare them. Although Advance Directives are highly recommended for individuals who have a serious or unpredictable medical condition, the best time to develop one is while you are still in good health and not during a health crisis. Advance Directives can only be made while you still have the capability of making decisions.
Each state has its own set of Advance Directive forms and regulates the use of Advance Directives (as an example, the time in which a Living Will goes into effect during your care varies in different states). The Advance Directives you make with one state's forms should be honored by other states. Even though Advance Directive laws are not enforced internationally, you may want to take your Advance Directives with other documents when you travel out of the country. They may be useful in case of emergency medical decisions.
The development of Advance Directives depends on your individual values, philosophy, religious or spiritual beliefs, lifestyle preferences, and unique circumstances, among other factors. It is important to have discussions about your directives with your loved ones and your health care professionals, so that it is clear to yourself and to them what you do or do not want.
There are many circumstances to consider. You may want to be resuscitated, for example, but not kept on life-sustaining equipment indefinitely. Some individuals do not want to be fed by a tube. Others want everything done but only for a period of time, in certain circumstances, or only if they are improving. You may decide that you want only to be kept comfortable and with as much pain relief as possible.
You will want to consider what your life-saving and life-sustaining choices will mean for you and your quality of life. Whatever you choose to address in your Advance Directives, think about what makes life worth living and what would make life intolerable for you. People often make their directive decisions based on their past experiences with loved ones who were seriously ill, as well as on spiritual, cultural, and personal values.
If you are designating someone to make these decisions for you, make sure he or she is comfortable with their role and responsibility and clearly understands your wishes.
There are many resources available to assist you with completing your Advance Directives. You can obtain simple forms from many hospitals, health care organizations, private attorneys, your state's bar association, county medical association or Office on Aging. Forms also can be obtained from national consumer rights organizations through the mail and the Internet, in software packages, and from some stationery stores. Most forms have checklists and spaces provided to add requests or change the wording on the document if you choose. Make sure to have the required signatures, dates, witnesses, and notarization if needed to be sure that the document is legally binding and complies with the laws in your state. Whether you use forms or create your own document, be as clear and specific as possible about your decisions regarding your end-of-life care.
It is very important that copies of your Advance Directives are with your medical records at your doctors' offices and with family members or other loved ones. If you are hospitalized and don't have a copy with you, you can make arrangements to have it sent to the hospital, complete a new one, or verbally explain what you want. Then the document can be placed in your medical records at the hospital.
Advance Directives involve very personal decisions and can be changed at any time as your circumstances and preferences change. It is common for people to put off discussing and planning for end-of-life health care options because it seems unnecessary or because they feel uncomfortable thinking about death. For most people, preparing Advance Directives while they are in good health and have the time to consider choices is easier than having to do it under the pressure of a health crisis. Persons who have Advance Directives in order often say that it has added to peace of mind for themselves and their loved ones.
There are many books and resources that can help you become informed about your options and help you make careful decisions about your future medical care. If you move to another state, you may also want to review the Advance Directive regulations and forms. It is a good idea to review your Advance Directives periodically to reaffirm what you have decided or to make any changes.
Please note that this information is intended to give you a general overview of the topic. It is not intended to replace advice or instruction of a health professional. We recommend that you consult your physician, nurse, or qualified health professional regarding the information in this publication. © 1994 Planetree, Inc. Reproduction of this material in any form is limited to license agreement.
Planetree Health Fact Sheets are developed by Planetree, Inc., a non-profit consumer health organization, founded in 1978. The Planetree Alliance includes hospitals and libraries which, among many other patient-centered concepts, promote the importance of access to health information for patients, families, and community. For more information regarding affiliation with the international Planetree Alliance, call (203) 732-1365 or visit Planetree, Inc. at www.planetree.org.