Most of us don’t like to think about worst-case scenarios. But we all know emergencies arise. What if something unexpected happened and you were not able speak for yourself? Who would make decisions about your medical care, and would they know what you really wanted? Advance directives help ensure that your wishes will be carried out in the event of a health emergency.
Whether you are 25 or 75, advance medical directives help you take control of future medical decisions and eliminate the need for your loved ones to make seemingly impossible choices at times.
It is important to note that there are many types of advance directives, including, but not limited to, a living will, medical power of attorney and do-not-resuscitate (DNR) order. The terminology is often confused, and understandably so. This guide will attempt to clear up the confusion and explain the most common ones used for health-care planning and decision-making.
What is an Advance Directive?
An advance directive is a set of instructions that outlines your health care wishes. They are written to indicate exactly what types of medical treatments you want—or do not want—if you become incapacitated.
An advance directive may be used in any circumstance when you are not able to communicate your medical wishes. It is not limited to terminal illness, permanent unconsciousness, or severe cognitive impairment. It may also include medical events such as temporary unconsciousness, stroke, coma, or an illness that prevents communication.
Advance directives are usually written to go into effect only when you are unable to make medical decisions or communicate your own medical decisions. The document is usually activated after a physician confirms your inability to make informed medical decisions, ensuring it’s only used when truly necessary.
These instructions may include, but are not limited to pain management, types of invasive procedures or interventions, organ donation wishes, artificial nutrition and hydration, as well as religious or cultural considerations.
What is a Living Will?
A living will, whether it is part of a broader advance directive or on its own, is a set of preferences for medical treatment should you become terminally ill or be in a persistent vegetative state. It is a written document outlining your health care wishes for end-of-life care in (and only in) the event that you cannot communicate or make these decisions on your own.
Living wills may address a myriad of treatments, including, but not limited to artificial nutrition and hydration, palliative care, surgical intervention, and mechanical ventilation as well as how long you want your life prolonged and quality of life considerations that influence these choices.
Importantly, a living will allows you the choice of accepting or refusing certain treatments ahead of time ensuring that your personal values guide your medical care. It also allows your healthcare professionals and your health care agent to act in accordance with your preferences notwithstanding any objection from others or without placing the emotional decision-making burden on your loved ones.
Note: A living will is NOT a “Will” as in a Last Will and Testament, which is a legal document that directs how your assets and property will be distributed after you pass away.
Medical Orders
Medical orders are created by medical professionals in consultation with their patients, in order to inform other medical professionals about your wishes regarding different life sustaining treatments.
A Do-Not-Resuscitate (DNR) order instructs the medical staff not to enact life-saving measures such as cardiopulmonary resuscitation or an automated external defibrillator. A Do-Not-Intubate (DNI) order instructs the medical staff that you do not wish to be intubated. A Portable Order for Life Sustaining Treatment (POLST) instructs emergency medical personnel regarding cardiopulmonary resuscitation (CPR) and the extent to which they should apply other medical interventions.
Note: Medical orders are not prepared by legal practitioners, but rather by medical professionals.
Medical Power of Attorney
A medical or healthcare power of attorney is a legal document that allows you to name one or more individuals as your health care agent(s). The agent(s) can make health care decisions on your behalf when you are unable to do so. In order for the health care agent(s) to act, the patient’s physician must first certify that the patient is unable to make medical decisions for himself.
A medical power of attorney empowers your health care agent(s) to speak with your physicians and enforce your health care wishes. The power of attorney document may specify exactly what decisions the agent(s) is and is not allowed to make and under what specific circumstances. In addition, the agent(s) may use the advance directive and/or living will as guide for such decision-making.
Putting It All Together
Together, the advance directive, living will and healthcare power of attorney ensure that your healthcare preferences are respected even if you cannot speak for yourself. In situations in which you cannot communicate or make healthcare decisions on your own, the advance directive is the general set of instructions for all medical decision making, the living will is the set of instructions specific to end-of-life decision making, and the healthcare power of attorney names one or more trusted individuals to make the decisions for you and under what circumstances.
Can I DIY This?
Yes. However, working with an attorney to prepare advance directives ensures that your documents reflect your specific individual wishes and are enforceable when needed. Requirements for advance directives vary by state. As such, it is important for the documents to be compliant so that they will be valid and will be honored when it matters most. In addition, legal errors or vague language in the documents could improperly reflect your wishes and result in confusion during medical emergencies.
Don’t leave your future medical care to chance. Contact the Dean Law Firm if you would like to set up a consultation to discuss preparing an advance medical directive.
