Advanced directives are significant for everyone living. Medical crisis can happen at any time. An advance directive will give everyone a peace of mind. It allows you to choose a trusted person to ensure your wishes are carried out when you are no longer able to communicate. It relieves the responsible party of guessing what decisions you may or may not choose for yourself.
An advanced directive is a legal document but is not necessarily legally binding. There may be circumstances in which your wishes may not be carried out exactly as you wish. A medical situation may occur that is not addressed in your advanced directive. In such a case, your health care provider and assigned proxy can only do their best to respect your wishes. This is why discussing what you prefer is important. Talking with your proxy ahead of time will give them a greater sense of what your decision would be.
If you do not have an advanced directive and you cannot communicate your decisions, the state where you live will determine who makes these decisions for you. This can be your spouse, parents or adult children. In some cases a close friend who is familiar with your values may be assigned as your proxy or a physician. Check the laws of your state for more information.
The most common advanced directive forms are Medical Power of Attorney and a Living Will. The Medical Power of Attorney is when you designate someone to be your proxy or agent to represent you and your values when a circumstance occurs and you are unable to speak for yourself.
A Living Will is a document that outlines your wishes more specifically with your end-of-life care. It informs health care providers what treatments you do and/or do not want. A Living Will may not cover all medical procedures that may arise. It is important that you discuss other situations that may arise with your proxy and health care provider, If necessary complete additional forms to prevent any confusion. Additional forms are usually directions regarding a single medical issue.
Additional Advance Directive Forms
- DNR – Do Not Resuscitate Order. This order become part of your medical record. It informs medical staff you do not want CPR or any other life support measures to be attempted.
- DNI – Do Not Intubate Order. This, once again, is to inform medical staff you choose not to be put on a ventilator.
- DNH – Do Not Hospitalize. This order is for those that are in long term facilities. It is used to inform the nursing staff that you choose not to be sent to a hospital for medical treatment, usually at the end of life.
- Out of Hospital DNR. This form informs emergency personnel of your do not resuscitate wishes.
- POLST / MOLST. Physician Orders for Life-Sustaining Treatment / Medical Orders for Life-Sustaining Treatment. These forms provide guidance to the medical staff for emergency matters. These are typically created when you are near the end of life and understand there may be specific decisions to be made on your behalf.
You may also want to consider documenting your wishes regarding organ and tissue donation, brain donation or whole body donation.
How to start with your planning
- Review your own values and wishes. This can help guide you not only with your decisions but who you may choose to advocate for you if you are unable to.
- Discuss advanced directives with your doctor. Advanced care planning is covered by Medicare as part of your annual wellness visit. Other health insurance may also cover advanced planning. Talking with your doctor may help you learn more of your current health and what type of decisions may come up. You can find information on Medicare advance planning here: https://www.medicare.gov/coverage/advance-care-planning
- Choose someone you trust as your proxy/agent. Let them know what your wishes are.
- Complete Advance Directive forms. To make your decisions official you must complete these forms.
- Share. Share these forms with your proxy, doctor and loved ones. Some states have registries that will store your advance directive for quick access by your health care provider and assigned proxy.
- Continue the discussion. Things change and sometimes this may require addition discussion and possibly updating forms.
Where to find advance directive forms
Most states have their own forms that you can access and complete free of charge.
- Contact your local area agency on aging, https://eldercare.acl.gov/Public/About/Aging_Network/AAA.aspx
- Download your state forms online
- AARP; https://www.aarp.org/caregiving/financial-legal/free-printable-advance-directives/
- American Bar Association; https://www.americanbar.org/groups/law_aging/resources/health_care_decision_making/Stateforms/
- National Hospice & Palliative Care Organization; https://www.caringinfo.org/planning/advance-directives/
- Local Veteran’s Affairs Office; https://www.va.gov/find-forms/about-form-10-0137/
If you spend time in more than one state you may consider preparing advance directives for each state and keep a copy in each location.
The American Hospital Association has created a card that can be carried in one’s wallet indicating they have an advance directive and its location. Below is an example.
It is important to remember that advance directives only recognizes your wishes with regard to health care. Upon death these forms are no longer valid. Should you have wishes to be implemented after you move forward, it is important to have estate planning documents also drawn up. Many of these documents can also be found on-line. Usually estate planning attorneys have free consultations. I recommend you take advantage of this. Free consultation not only allows you to decide whether that attorney is a good fit for you it also allows you to gather information of your state requirements and which estate planning documents work best for your situation.
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Best Wishes
