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Your Guide to Health Care Directives
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Your Guide to Health Care Directives

October 10, 2018

It’s not just quantity of life that’s important to think about as we age. It’s also important to think about our quality of life. Medical science is finding new ways to give people with terminal illness or severe injuries more time, but if that extra time comes with significant risk of pain, infection or unconsciousness, it’s not necessarily what everyone wants.

Two elderly people sitting on a bench overlooking the sea

To make sure their wishes are known about medical treatment in an emergency or at the end of life, many people create advance health care directives. Read on to learn more about them and how to help a loved one create one.


What Are Advance Care Directives?

An advance health care directive is a legal document that is valid only when a person is unable to speak for themselves and someone else must make medical decisions for them. It is a document that you can change as your situation or point of view changes. 

The advance health care directive can give doctors and family members guidance on what kinds of treatment you would and wouldn’t want, such as the use of emergency treatment to keep you alive. It can also appoint a trusted representative to make health care decisions for you. Without an advance health care directive, doctors and family members are left to guess what type of medical treatment you would want in an emergency or at the end of life.

What Is the Difference Between a Living Will and a Health Care Directive?

A living will is a type of advance health care directive. It is a written document that allows people to explain ahead of time, in detail, what types of and how much lifesaving medical treatment they would or would not want in different situations.
Some of the most common emergency treatments covered by advance health care directives are:
  • CPR. This procedure is used to revive someone whose heart or lungs have stopped working. If a person does not want CPR to be performed, they should get a do-not-resuscitate (DNR) order from a doctor and include that information in their living will.
  • Intubation. This procedure involves inserting a tube through the mouth and into the airway of a person in order to put them on a ventilator that will breathe for them. If a person does not want to be intubated and placed on a ventilator, they should get a do-not-intubate (DNI) order from a doctor and include that information in their living will.
  • Feeding tubes. These are used to provide the body with nutrients and fluids when a person is unable to eat or drink normally. If a person does not want to be given a feeding tube or would only want it used for a certain amount of time or in a certain situation, they should put that information in their living will.
To understand more about these treatments, talk with your or your loved one’s doctors and a social worker or patient navigator at your loved one’s health system. They can explain how effective these treatments are and their potential effects on quality of life. Once you have that information, you and your loved one can make informed decisions about the use of emergency life-saving treatments.

What Is a Power of Attorney?

A power of attorney is another kind of advance health care directive. It is a legal document that gives a specific person, called a “health care proxy,” permission to make health care decisions for another person if they become unable to make those decisions for themselves.

A power of attorney is a useful complement to a living will, because it’s impossible for a living will to address every possible situation that could come up. 

It’s important that a trustworthy person be selected as health care proxy. Most people choose a close family member. If an elderly family member wants to select you as their health care proxy, before you agree, make sure you feel comfortable with that role and that you’re prepared to make time, on an ongoing basis, to understand the person’s values and the role those values play in what they want from emergency and end-of-life care.

Can Family Members Override Advance Directives?

Sometimes family members try to override advance health care directives. This might happen if a family member disagrees with their loved one’s decision to forego certain treatments or because they believe their loved one had changed their mind. This can create a heartbreaking situation for the family and a confusing one for health care providers. 

To avoid this situation, it’s essential for people with advance health care directives to talk openly and honestly with family members about their wishes prior to end-stage illness or a life-threatening injury. It’s also important for them to amend documents and talk to their health care proxy if they change their mind about something in their advance directive, to make sure their new wishes are understood.

How to Create an Advance Health Care Directive

Each state has different forms and rules for creating advance health care directives. A witness and notary may be necessary. Download state-specific advance directives at caringinfo.org.

Once an advance health care directive is in place:
  • Keep the original documents in a safe but easy-to-access place.
  • Be sure attending physicians and the health care proxy know about the directive and have copies.
  • Keep a copy when traveling and always be sure a wallet card has information about the directive and the name of and contact information for the health care proxy. 
Encouraging family members, especially those who are elderly, to create an advance health care directive can give your family peace of mind, now and in the future. 

 

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