The Components of an Advance Directive
This legally-binding statement for how you would like to be treated at the end of your life is made up of two parts:
1. Naming a Health Care Proxy, who can advocate for your care when you may not be able to
2. Creating a Living Will, stating the types of medical treatments you do and do not want at the end of your life
Choose a Health Care Proxy
Also known as a health care power of attorney, this person can make health care decisions on your behalf should you no longer be able to do so. Fill out the paperwork with witnesses and get the forms notarized, if necessary. [Dig Deeper: Naming a Health Care Proxy]
Decisions A Health Care Proxy Can Make Summed Up In 8 Bullet Points
- Choices about medical care, including medical tests, medicine, or surgery
- The right to request or decline life-support treatments
- Choices about pain management, including authorization or refusal of medication or procedures
- Admission to an assisted living facility, hospital, hospice, or nursing home
- Choices about where to seek medical treatment, including the right to move you to another facility, hospital, or state
- The right to see and approve the release of your medical records
- The option to take legal action on your behalf in order to advocate for your health care rights and wishes
- The right to apply for Medicare, Medicaid, or other programs or insurance benefits on your behalf
Where There’s A Living Will There’s A Way
A Living Will is a roadmap for the important player in your life: The doctors use this as a guide to manage your care, and your Health Care Proxy uses it to make sure what you want is being fulfilled.
This lets you choose the types of medical treatments you want, and the types you don’t want. This focuses on life-support treatments and medical procedures, devices, or medications to keep you alive when your body might not be able to keep itself alive on its own. If you’re suffering from a terminal or progressive illness, if you’re ill and unlikely to recover, or if you’re in a coma (persistent vegetative state).
Enough Talk, Let’s Do This!
1. Obtain your state's Living Will or Advance Healthcare Directive form. [Find your state's Advance Directive form here]
2. Indicate whether you would like to receive life-support treatments at the end of life or whether you would not like to receive life-support treatments at the end of life.
3. Have a witness, who must be over 18 and can’t be your health care proxy, countersign the document.
4. If you can’t find any witnesses to sign it you’ll have to get it notarized at a local post office, bank or government office.
Don’t Go Far Without A DNR...If You Want One
Pardon our acronym overload but you fill out a Do Not Resuscitate (DNR) with your doctor when you don’t want cardiopulmonary resuscitation (CPR) or advanced cardiac life support (ACLS) if your heart or breathing stops.
Make sure the DNR form is with you when you are receiving medical treatments, and displayed prominently in your home in case of an emergency.
Never Feel Pressured To Get A DNR
If you want every possible treatment at all times then don’t fill out a DNR. The doctor default is to never give up and if there’s no DNR then you will continue to receive treatment regardless of the cost or outcome.
When does a DNR go into effect?
A DNR only applies in situations where the patient’s heart or breathing has stopped. Even with a DNR, a patient may still receive medical treatments, medicines, surgeries, and procedures.
DNRs and Advance Directives Are Different Animals
Well, they’re not actually animals, but if they were they’d probably be really cute and helpful. Like Meerkats. But be aware that an Advance Directive accounts for all your choices and decisions; a DNR is done in conjunction with a doctor. Even if your Advance Directive or Living Will states that you wish not to be resuscitated, you need to fill out the specific DNR forms with your doctor. Without a proper DNR, doctors, emergency medical service responders, and other health professionals will attempt resuscitation if your heart or breathing stop.
Why You Need All of This
This lets family and caregivers know the types of treatments you want and don’t want, the way you would like to be cared for as you age, and who should make decisions for you if you can't make decisions for yourself.
Most importantly, it takes an enormous amount of stress off your family, since they won’t have to make these often difficult decisions about your care. Plus, all the cool kids are doing it. [Dig Deeper: State-by-State Advance Directive Forms]
When a Living Will Goes Into Effect
A Living Will is only used if you are deemed incapacitated and incompetent by at least one doctor. If you are merely incapacitated, as in a situation where you may not be able to speak but you are likely to recover, it won't go into effect (though this may be a situation in which your health care proxy can act on your behalf). So long as you are mentally competent and can speak or communicate on your own behalf, it won't be used.
How to Complete a Living Will
Each person must create his or her own Living Will; no one can create one on behalf of another person. In addition, a person who creates one must be of sound mind in order for the living will to be legally binding.
Evaluating Life Support Treatments
All life-support treatments have their upside and downside. For each treatment, consider the following questions, which you should go over with your doctor:
- What purpose does this treatment serve?
- What are the side effects?
- Does this treatment usually improve my overall health, or does it simply extend my life?
- What type of medical equipment will be used and how will it affect my body (i.e. ventilator, feeding tube, dialysis, antibiotics.