Facts on Health Care Advance Directives

What is a Health Care Advance Directive?

A health care advance directive is a written or oral statement provided by an individual that instructs a physician to provide, withhold, or withdraw life-prolonging procedures in the event of an incapacitating medical event that makes it impossible for the patient to make decisions.

There are three main types of advance directives: a living will, a health care surrogate designation, and an anatomical donation. In this case, a “living will” differs from a traditional living will in that it focuses specifically on medical issues and takes effect while the patient is alive. A health care surrogate designation is a document that names a legal representative empowered to make health care decisions on the patient’s behalf. An anatomical donation specifies how the patient wishes specific organs to be donated or used in the event of death.

  • Types of Health Care Advance Directives: Describes and discusses the various kinds of advance directives and offers a walk through of various factors that go into their use, such as the designation of a health care agent and determining which treatments are or are not acceptable in the event of incapacitation. From the Mayo Clinic.

How Do You Make a Health Care Advance Directive?

In many jurisdictions, an attorney is not needed to make any kind of health care advance directive. Specific forms are required, and must be witnessed by a given number of impartial witnesses. Resources for finding the necessary forms are provided below. In all cases, advance directives are useful because they help ensure that the patient’s desires will be respected in medically critical situations. In cases where there is no advance directive, family members and the presiding physicians must make decisions in the absence of input from the patient. This may lead to stress, conflict, and difficulty making choices that are right for the patient. Friction may result in cases where the opinions of families and physicians differ and there is no designated health care agent, that is, someone chosen in advance to make health care decisions on the patient’s behalf.

  • Download Your State’s Advance Directives: Comprehensive resource offering free access to forms related to advance directives. Includes documents for all states. Provided by the National Hospice and Palliative Care Organization.
  • How to Make an Advanced Directive: Information focused on advance directives for cases in which the patient is incapacitated for mental health reasons. Focuses on Texas, but includes helpful information applicable to many situations.
  • Advance Directive Forms and Explanation: Defines terms and issues related to advance directives and gives advice on ensuring that the directives are maintained and used in an emergency. From the Hospice of Michigan.
  • Patient Guide: Advance Health Care Directives: From the Institute for Good Medicine of the Pennsylvania Medical Society, a detailed guide to advance directives, health care agents, health care representatives, and end-of-life planning.

How to Decide About Key Issues

Creating a health care advance directive requires one to make binding choices about difficult end-of-life issues. Though an advance directive is typically easy for the initiator to change as their wishes evolve, it must be handled seriously in case of an emergency that brings it into effect. Many people benefit from some form of help when deciding on key issues, such as whether certain forms of life support should be used and when these measures should be discontinued. A family physician can offer a point of first contact in these discussions. There is also a variety of counseling services available through hospitals and private therapists who can guide the patient and family. As each person is different, the procedure and final decisions will differ from one patient to the next. Each person must balance the ideas of dignity, prognosis, quality of life, and other issues.

  • FCA: End of Life Decision Making: Comprehensive article on all aspects of end-of-life care including advance directives, special situations in which the application of directives may be altered, financial planning, and post-life planning.
  • Center for Healthcare Decisions: Nationwide nonprofit organization that collects and provides a large range of information relating to empowering patients and making informed decisions on health care, including a large number of resources specifically related to end-of-life care and critical treatment.

Why its Important

A health care advance directive helps ensure that a person’s specific preferences regarding their medical care are respected. It also helps the patient’s family at a difficult time when emotion and stress may cloud decision-making. Health care advance directives are designed to be easy to make, maintain, and use, and they are most effective when they are considered and recorded long before they must be used. Even in perfect health, it is never too soon to make the important decisions that will ease the burdens of loved ones at such a difficult time.

  • The Agent’s Role in End-of-Life Care: Overview and useful checklists for choosing a health care agent and for being an effective health care agent in the event that you are chosen. From the Attorney General’s Office of California.
  • Communicating Your End-of-Life Wishes: Instructive booklet on planning for end-of-life care, expressing health care wishes, and gathering the information necessary to make informed choices about critical care.
  • Advance Directive Resources from NIH: Diverse array of Internet resources and further reading on advance directives, related issues and laws, and other useful information from Medline Plus, a service of the National Institutes of Health.
  • Free Living Will Forms and Consultations: Information and instructions on completing advance directives, and answers to a variety of questions related to them, from the Health Care Decisions program of Phoenix, Arizona’s Hospice of the Valley.

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