Advanced Care Planning
Understanding Advance Directives
Rhonda L. Randall, D.O., (above) and Nancy Williams, R.N., give practical tips for discussing end-of-life wishes. Watch now
Making decisions about medical care is not easy, even when we are healthy. We often take for granted that when difficult decisions will have to be made regarding our future health care, we will be able to make those decisions ourselves. But at some point, you may become unable to make your own health care decisions. That's why it's important to think and talk about your wishes and beliefs with your loved ones long before critical decisions must be made.
Do you know what health care treatments you would and would not want if you could not speak for yourself? Do other people know what your wishes are? Each year thousands of us are faced with making medical decisions for ourselves or for our loved ones. And all too often, what we hear from those having to make such decisions is, "I wish I had talked to 'my loved one' about this, so I would have known what he/she wanted."
You may be thinking of making a health care advance directive (such as a living will or durable power of attorney for health care), or you may have already signed one. But just having a written advance directive does not ensure that your wishes will be understood and respected. Advanced care planning is the process of understanding, discussing and planning for a time when you cannot make your own medical decisions. This typically involves learning about treatment options, thinking about your own wishes and values, talking about your decisions with your loved ones and your physician, and documenting your wishes, before a crisis occurs.
This will help those closest to you and your physician to provide the type of medical care you prefer, when you cannot make your own decisions. For most adults, a good way to document your advance care plan is to use a power of attorney for health care form. This document allows you to appoint another person to be your decision-maker or health care agent when you are not able to make your own decisions. However, you should consult with an attorney to determine what is appropriate for you.
An advance directive is a legal document that allows you to plan and make your wishes known in the event that you are unable to communicate. An advance directive usually consists of a living will and/or a medical (health care) power of attorney.
A living will is a document in which you express your preferences for the type of medical treatment you wish to receive, or not receive, in the event you are no longer able to make these decisions for yourself. A living will goes into effect when you are no longer able to make your own decisions. This document may also be called a "directive to physicians", a "health care declaration" or a "medical directive."
Medical power of attorney
A medical power of attorney is the document that allows you to select the person you trust to make health care decisions for you and to represent your wishes and goals of care when you become unable to do so. This person is authorized to speak ONLY if you can't. A medical power of attorney goes into effect when your physician declares that you are unable to make your own medical decisions. This document may also be called a "health care proxy," "appointment of health care agent" or "durable power of attorney for health care." The person you select can be known as a health care agent, surrogate, attorney-in-fact, or health care proxy.
The Five Wishes is a tool that addresses your personal, emotional and spiritual needs as well as your medical wishes. You can choose the person you want to make health care decisions for you if you are not able to make them for yourself, and you can say exactly how you wish to be treated if you become seriously ill.
- Wish 1: The person I want to make health care decisions for me when I can't make them for myself
- Wish 2: My wish for the kind of medical treatment I want or don't want
- Wish 3: My wish for how comfortable I want to be
- Wish 4: My wish for how I want people to treat me
- Wish 5: My wish for what I want my loved ones to know
Five Wishes is written in plain language and is available in 23 different languages. It meets the legal requirement in 42 states and is useful in all 50.
Make your wishes known
Understanding your wishes can provide comfort and peace of mind for your loved ones. But remember, it's up to you to take the initiative and start the conversations about your wishes. Your family or loved ones are not likely to raise the issue for you. One way to start the conversation is to talk about why you have decided to talk about these issues. Or, you could share an article or story about the topic to start a conversation about your own wishes.
Once you have completed your advance directive, be sure to sign and witness the form as required. If you complete a new advance directive, it typically invalidates the previous one. It is usually a good idea to destroy all copies of previous advance directives, or write "Revoked" in large letters across the top. Tell your lawyer if he or she helped prepare previous forms for you. Tell your health care agent, family members, physician and other care providers, that you have completed an advance directive. Talk with them about your wishes, and give them copies of your completed form. If you are admitted to a hospital or other health care facility, bring a copy to be included in your medical records. Keep the original copy with your important papers.
Remember, your advance directive should reflect your wishes. The document usually does not expire, and it can be updated as needed. Reassess your decisions over time, as your views may change. It is important that you review these issues and discuss your choices as your personal health or circumstances change your life.
Since every state has different laws, you should use a form that you know is acceptable where you live and/or where you are most likely to receive care. For more information, visit CaringInfo.org.
Many law firms and legal service organizations provide forms with other basic estate planning services.
Many states have sample forms that are available online and from local senior programs.