Advance Directives

________________________________________________________________________

KEY POINTS

• Advance directives are written instructions about what kind of medical care you want if you are not able to make decisions yourself. They do not go into effect until you are no longer able to speak for yourself.
• Three examples of advance directives are a living will, durable power of attorney for healthcare, and a do not resuscitate order.
• Give copies of your advance directives to family members and those you have chosen to make decisions for you. Also give copies to your healthcare providers.

________________________________________________________________________

What are advance directives?

Many of us avoid dealing with issues that concern the end of life. However, it’s important for you to plan what kind of care you want in the event of a life-threatening problem or if you are nearing the end of your life. Talk to your healthcare provider about your wishes and write them down. If a crisis occurs and you are unable to speak for yourself, your healthcare provider will know what kind of care you want and what kind of care you don’t want. Without these written instructions, your wishes might not be known and then cannot be honored. That can make it even harder for loved ones when you are very ill.

Advance directives are written instructions about what kind of medical care you want if you are not able to make decisions yourself. They do not go into effect until you are no longer able to speak for yourself. Advance directives are legal only if you sign them when you are mentally competent and there are witnesses when you sign each document. “Mentally competent” means you are able to understand information and make decisions.

Advance directives can help in several ways:

• You can list what medical procedures you do and don't want. Some specific things to consider include:
  • Use of a breathing machine
  • Resuscitation (CPR) if your heart stops beating or you stop breathing
  • Tube feeding or IV fluids and the use of certain medicines, such as antibiotics
  • Treatments such as dialysis to clean your blood
• You can decide if you want to donate any part of your body.

There are many forms of advance directives. You need to know the laws in your state and fill out the forms your state recognizes. There are various ways to get forms for advance directives. For example:

• Your healthcare provider or lawyer
• The National Hospice and Palliative Care Organization, which can be contacted by calling-1-800-658-8898 or visiting their Web site at http://www.nhpco.org
• Your state health department, local hospitals, or state bar association
• The Caring Connections Web site at http://www.caringinfo.org/i4a/pages/index.cfm?pageid=3289, where you can download forms for advance directives for your state

Three examples of advance directives are:

• A living will
• Durable power of attorney for healthcare (DPOA-HC)
• Do not resuscitate (DNR) order

What is a living will?

A living will is a legal document that states your wishes for your medical care if you have a serious or terminal illness. You can complete this document at any time and it is best to do it when you are healthy and able to ask questions and make these important decisions about your care.

A living will is not used to say who you want to make decisions for you when you cannot make them yourself.

What is a durable power of attorney for healthcare?

A durable power of attorney for healthcare (DPOA-HC), also called a medical power of attorney, is another legal document regarding medical care. It allows you to identify someone, such as a family member or friend, to make medical decisions for you if you cannot make them for yourself. This document goes into effect if you are unconscious or unable to make decisions.

You must be mentally competent at the time you sign a DPOA-HC for it to be legal. If you have a brain disease that gets worse over time (such as Parkinson's disease or Alzheimer's disease), you may wish to create and sign the DPOA-HC papers early in the illness.

What is a do-not-resuscitate (DNR) order?

A do-not-resuscitate order tells the hospital staff what you want to be done if your heart stops and you are not breathing. Your healthcare provider puts this order in your medical chart.

To create DNR orders for places other than a hospital, talk to your healthcare provider. Special forms called orders for life-sustaining treatment can be prepared for you to keep at home and at your provider’s office.

Who should have copies of my advance directives?

Knowing what you want helps your family make decisions about your care. It makes it less stressful for them and allows them to focus on you. It is a good idea to discuss your wishes with your friends, family members, and your healthcare provider.

Once you have signed an advance directive, keep the papers in a safe place. If you put them in a safe deposit box, make copies because others may not have access to your box when the documents are needed. Give copies of your living will and durable power of attorney for healthcare (DPOA-HC) to family members and those you have chosen to make decisions for you. Then they will have the documents if they are needed.

Give copies to your primary healthcare provider. If you see several providers regularly, like an internist and a cardiologist, give each of them a copy. Always take copies with you if you go to a hospital or surgery center for treatment.

Take care of yourself and your family by making decisions about medical care while you are able to do so.