A Guide for Families:
Having Your Say: Advance Directives

Living Will vs. Medical Power of Attorney

It might be best to have a Living Will and appoint a health care agent or proxy. However, in some states, laws may make it better to have one or the other. It may also be possible to combine both documents into a single document that describes treatment choices in a variety of situations -- you might want to seek medical advice about these situations and choices -- and names your health care agent.

Designating a health care agent as part of a Medical Power of Attorney provides more flexibility for future decisions unanticipated in a Living Will. A health care agent, along with a written Living Will, can provide guidance in the absence of the health care agent or support decisions made by the health care agent based on knowledge of your wishes.

Modifying an Advance Directive

You may modify, update or even cancel an Advance Directive at any time in accordance with state law. Any change or cancellation should be written, signed, and dated in accordance with state law, and copies should be given to your doctor or to others to whom you may have given copies of the original documents. Be sure to notify your health care agent of any changes. Some states allow an Advance Directive to be changed by oral statement but, if possible, it is always preferable to put your changes in writing.

If you change or cancel an Advance Directive while you are in any health care setting, the provider of those services should be advised of your decision with new documents to replace any outdated ones.

Even without a change in writing, your wishes stated verbally to your doctor may carry more weight than a Living Will or Medical Power of Attorney, as long as you are competent to make decisions and can communicate your wishes. Again, be sure to clearly express your wishes and be sure that they are understood. It is always better if there are witnesses to your statements.

Retrieving the Advance Directive

Make sure that someone, such as a close family member, legal advisor etc., knows that you have an Advance Directive and knows where it is located. In the case of a health care proxy be sure that person has a current copy. You should also consider the following:

If you spend a great deal of time in more than one state, you should consider having an Advance Directive in each state. Be sure to keep a copy in each location that you reside.

• If you have an Advance Directive -- that is, a Living Will or Medical Power of Attorney -- give a copy to your health care agent or health care proxy among others.
• Give your physician and the long term health care facility (e.g. a nursing facility or assisted living residence), or other health care provider, a copy of your Advance Directive and advise them to make it part of your permanent medical record.
• Keep a second copy of your Advance Directive in a safe place where it can be found easily if it is needed. However do not keep in a safe deposit box, as that is not easily accessible to others.
• Keep a small card on your person that states that you have an Advance Directive, where it is located, and who your agent or proxy is if you have one.

Under federal law, when you are admitted to most health care settings you will be asked if you have an Advance Directive. If so, the facility will want a copy as part of your medical record.

Finally, as you’ve read in this pamphlet, an Advance Directive may prevent anguish and turmoil within families and provide clear guidance to health care and long term care providers. An Advance Directive should be considered an essential component of future planning just as much as financial planning, life or disability insurance or drawing up a will.