Medicare memo: What are advance directives?

An advance directive is a type of legal document that explains how you’d like medical decisions to be made for you if you cannot do so yourself. You can have multiple documents, and in these, you essentially spell out how you’d like care to be given for end-of-life and other medical care directions for situations in which you are unable to make choices yourself.

Advance directives are used by your health care providers and loved ones, and they are meant to help you think about and plan for how you’d want to be cared for in various circumstances.

An advance directive may include the following information:

• A durable power of attorney for health care: This document names a specific person to be your health care proxy. You appoint this person to make health care decisions for you in the event that you can’t make them yourself.
• Directions for end-of-life care: This document gives directions about the kind of health care you want or don’t want at the end of your life. You can state which medical treatments you want to accept or refuse, if the time comes when you are unable to express these wishes.
• After-death wishes: These documents state your wishes about issues important to you, such as organ and tissue donation, burial, cremation, etc.

It’s important to know that you can change your advance directives at any time, even after the documents are signed, as long as you are able to make decisions for yourself. Your situation may change, and your directives may need to change, too. Ideally, your advance directives become a standard element of your estate. You can review and update the documents as needed, like you may do with your will and other legal documents.

Also, any clear verbal direction that you give to your physician will generally override your written advance directives, as long as you are able to decide for yourself and can clearly communicate your wishes.

Advance directives aren’t easy to talk about. No one likes to think about being in a situation where directives might be needed. But it can also be very comforting to have the decisions made and in place—for you and for your family and friends. In the worst of times, advance directives may help ensure that your wishes are carried out. And your loved ones will be relieved from having to make difficult end-of-life decisions about you, without you.

The time to create advance directives is when you don’t need them—when you are well. You can start by learning about advance directives and the laws in your state. Your state or local Office on Aging is a good resource. Also, the National Hospice and Palliative Care Organization (NHPCO) offers free, state-specific advance directives and advice for communicating your wishes. A lawyer is not required to complete advance directives, but you do need to follow the laws in your state.

When you’re ready, you may want to reach out to family or other loved ones to help as you consider these important decisions. Once your advance directives are completed, be sure to provide a copy to your health care proxy and keep another copy in a safe place. You also need to ensure that a copy is placed in your medical record. Your doctor or the hospital where you will likely be treated can help you.