An advance medical directive is a legal document or group of documents that spell out how you want medical decisions concerning you to be made when you cannot make them yourself.
Learn the significance of an advance medical directive and the different types of directives to include this important documentation in your long-term care planning.
What Is an Advance Medical Directive?
An advance medical directive refers to written, legal instructions on how decisions about your medical care should be made if the time comes when you cannot make these decisions on your own. The instructions only take effect when you become incapacitated or unable to speak for yourself—for example, if you go into a coma, become seriously injured or terminally ill, or are otherwise near the end of life. At such a time, the documentation helps doctors, other caregivers, and family members make choices that align with your preferences.
- Alternate name: health-care power of attorney
How an Advance Medical Directive Works
Patients typically have the right to make their own decisions concerning their health care and may choose to accept or refuse medical treatment. But if you become too ill to make those decisions, your doctor will generally consult your family or even friends or clergy for guidance on treatment. Not only can such a scenario create confusion for those left to make decisions on your behalf, but it might mean that those decisions aren't the ones you would have made.
Completing an advance medical directive form and giving it to your doctor and caretakers while you still have the ability to convey your medical care preferences can help guard against this scenario. It ensures that professionals and loved ones make decisions you approve of.
For example, let's say that John is a 21-year-old taxi driver. Until age 17, his mother served as his caretaker. But now that he is an adult, and his mother is facing medical issues of her own, John wants to obtain an advance medical directive to guard against the scenario of a car accident or other event that might force his mother to make medical decisions for him that he might not agree with and that might burden her. Through advance medical directives, he names a close cousin as his proxy and specifies the treatments he would want to receive if he were to become incapacitated.
Among others, he opts for cardiopulmonary resuscitation (CPR), which he believes might be effective at his young age. He then gives copies of the documents to his doctor, his cousin, and his mother. If and when the time comes when he can no longer make medical decisions for himself, his cousin and doctor would turn to his directives to make decisions about resuscitation and other treatments according to his wishes.
Types of Advance Medical Directives
There are two main types of these directives:
- Durable power of attorney for health care: This type of advance medical directive lets you specify a health-care proxy. Also known as a healthcare agent, representative, or surrogate, this is a person who understands your wishes and whom you trust to make medical decisions on your behalf when you're too ill to make them. Although you can complete this form alone or in addition to a living will, it can be vital in the event you become incapacitated because it avoids the need for doctors to consult with people whom you may not otherwise have entrusted with your medical decisions.
- Living will: In this advance medical directive, you specify the treatments you want and don't want (and under which conditions they apply) if you were to become permanently unconscious or terminally ill. Instructions might cover the use of life-sustaining measures and interventions, such as breathing machines or dialysis, resuscitation in the event you stop breathing or your heart stops, and palliative care, as well as organ or tissue donation. A living will is best used in conjunction with the durable power of attorney for health care, as it doesn't in and of itself give someone else the authority to make decisions for you. But if you don't have a proxy, a living will can communicate your medical preferences to others.
Combined advance medical directives include both of the above components in a single document and may include additional components in an "Other wishes" section. In this section, you might, for example, state your preferences for an autopsy or expand on your preferences for a particular treatment.
How to Get an Advance Medical Directive
Follow these steps to obtain and complete your forms.
Understand state laws. Each state has its own laws for advance medical directives that may dictate the following:
- What format an advance medical directive must take and what minimal provisions it must contain in order to be legally enforceable
- Who can complete an advance medical directive (typically, any competent person who is 18 or older)
- Who can and cannot be named as a proxy (typically, a competent individual aged 18 or older)
- What formalities must be observed when an advance medical directive is signed (for example, if witnesses must be present, who can serve as a witness, and whether the signature must be notarized).
- What provisions must be made to comply with the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA)
In certain states, such as Connecticut, your healthcare proxy cannot also serve as a witness to your signature.
Obtain the durable power of attorney and living will for your state. You can typically get these documents from your state health department, local Area Agency on Aging, physician, or lawyer. If, like many states, yours uses a universal form, use that form instead.
Talk with professionals to evaluate your options. A doctor can help you understand the various healthcare options to consider in the living will and the implications of your choice of a proxy.
Complete and sign the documents. Make the necessary elections in the forms, including the proxy in the durable power of attorney for health care and the desired treatments in the living will. Enlist the help of an attorney if needed. Then, sign the documents and have the signature witnessed by suitable witnesses or notarized if required by your state.
Distribute the directive to others. Provide copies of the documents to your doctor, health-care proxy, and family or friends.
Modify the documents as needed. Over time, changes in your health, marital status, or other circumstances might change your choice of proxy or treatment preferences. Review your advance medical directive at least once every decade and adjust it according to state guidelines to accommodate your present situation.
- An advance medical directive is a legal document or group of documents used to communicate your preferences for medical treatment to others when you cannot convey them yourself.
- It comprises a durable power of attorney, in which a health-care proxy is assigned, and a living will, in which you express your preferences for certain treatments.
- You can get the advance medical directive from your state health department and must comply with state law when making selections in the documents.