A Guide for Families:
Having Your Say: Advance Directives

Experience shows that a catastrophic medical event, such as an accident or a stroke, can leave a person incapacitated and unable to make decisions or to communicate with others. That leaves treatment decisions concerning what is in your best interest up to family members, significant others, health care providers or the judicial system. In order to avoid this difficult situation, all adults--not just the adults with chronic diseases or other medical conditions--should plan for their future health care treatment preferences and complete an Advance Directive document that specifies personal preferences regarding acceptable and unacceptable medical treatments.

There is a fairly easy way to stay in control--to “Have Your Say”--about these events that are often fraught with emotions. An Advance Directive document can provide specific guidance regarding a person’s treatment preferences in a situation such as an irreversible coma following a debilitating stroke.

Typically, a person may not know what medical treatments he or she may prefer or reject. The advantage of preparing an Advance Directive is that the process serves as a guide for those who may need to make informed decisions regarding major treatments such as tube feeding or ventilator care. You decide in different scenarios how you wish to be treated and even “if” you wish to be treated. Since an Advance Directive prescribes your care plan if you are incapacitated, it may be wise to involve family, significant others, a religious advisor, your physician, other medical professionals or an attorney (however, an attorney may not be required to complete this document).

Each state government may regulate the preparation of an Advance Directive differently. This makes it important to work within a state’s framework to ensure that health care providers, including nursing facilities and assisted living residences, honor your choices regarding, for example, situations involving permanent coma, persistent vegative state, brain death, and comfort care.

Two types of Advance Directives

There are two legal forms of an Advance Directive: 1) a Living Will; and, 2) a Medical Power of Attorney (which may also be called a “durable power of attorney for health care” or “health care proxy”).

An Advance Directive allows you to state your choices for health care or to name someone to make those choices for you if you become unable to make decisions about your medical treatment or to communicate your preferences. It is best to complete an Advance Directive as part of a strategy for financial planning, retirement or long term health care. Preparation avoids having to deal with this matter in the event of unexpected serious illness or debilitation.

Living Will

A Living Will generally states the kind of medical care you prefer (or do not want) if you become unable to make your own decision or cannot communicate. It is called a "Living Will" because it takes effect while you are still living.

Most states have their own Living Will forms, each somewhat different. It may also be possible to complete and sign a preprinted Living Will form available in your own community, draw up your own form, or simply write a statement of your preferences for treatment. Generally a Living Will needs to be signed in the presence of two witnesses, and in some states it must also be notarized. You may also wish to speak to an attorney, your physician, health care or long term health care provider to be certain the Living Will is properly prepared to ensure that your wishes are understood and followed. An Advance Directive should be completed prior to there being any question about competency of the individual, as when diseases such as Alzheimer’s or other dementias are present.

Medical Power of Attorney

A Medical Power of Attorney is a signed, dated, and witnessed document -- some states require notarization too -- naming another person, such as a husband, wife, daughter, son, or significant other as your “agent” or “proxy” to make medical decisions for you if you are no longer capable of making them or unable to communicate your preferences. You can include instructions about any treatment you wish to avoid.

In selecting your health care agent, it is important to communicate with this person in advance and that they agree to the designation; they could be the ones making treatment decisions for you if future medical situations require it. The agent needs to have reached majority age for your jurisdiction, and not be a health care provider that is treating you. Be sure to verify any other exclusion in your jurisdiction.

Note that a Medical Power of Attorney and the more commonly known “Power of Attorney” -- often refereed to as Non-Durable Power of Attorney -- are not the same. Power of Attorney allows a person to act on matters you specify, such as financial matters. Generally speaking, the person holding the Power of Attorney cannot also be designated as the Medical Power of Attorney. Again, this information needs to be confirmed for your state.