Advance Directives

What Are Advance Directives?

Advance directives are legal papers that tell your loved ones and doctors what kind of medical care you want if you can't tell them yourself. The papers let you state ahead of time what types of treatments you would like and who you choose to make sure your wishes are carried out. Planning your future health care is an important step toward making sure you get the medical care you would want.

All adults should have advance directives. It’s best to fill these out when you’re healthy in case you become ill or unable to make these decisions in the future. Think about taking action now to give someone you trust the right to make medical decisions for you. This is one of the most important things you can do.

What Are the Types of Advance Directives?

Living Will

A living will is a document used for people to state whether or not they would like to receive certain types of medical care if they become unable to speak for themselves. The most common types of care addressed by a living will are:

• The use of machines to keep you alive. Examples include dialysis machines and ventilators (also called respirators).
• “Do not resuscitate” (DNR) orders. These instruct the health care team not to use cardiopulmonary resuscitation (CPR) if your breathing or heartbeat stops.
• Tube feeding
• Withholding food and fluids
• Organ and tissue donation

Durable Power of Attorney for Health Care

A durable power of attorney for health care is a document that allows people to name another person to make decisions about their medical care if they are unable to make these decisions for themselves. (It is also called a health care proxy or medical power of attorney for health care.) People often appoint someone they know well and trust to carry out their wishes. This person may be called a health care agent, surrogate, or proxy.

Why Are Advance Directives Important?

Filling out advance directives gives people control over their health care. Choices about end-of-life care can be hard to make even when people are healthy. But if they are already seriously ill, such decisions can seem overwhelming. Some cancer patients want to try every drug or treatment in the hope that something will be effective. Others will choose to stop treatment. Although patients may turn to family and friends for advice, ultimately it is the patient’s decision.

It’s important to keep in mind that if a day comes where you choose not to receive or to stop treatment to control your disease, medical care to promote your well-being (palliative care) continues. This type of care includes treatment to manage pain and other physical symptoms, as well as support for psychosocial and spiritual needs. You have the right to make your own decisions about treatment. Filling out advance directives gives you a way to be in control.

When Should I Fill Out Advance Directives?

Ideally, these documents should be completed when you’re healthy. Yet many people connect filling out advance directives to making decisions near the end of life. But you don’t need to wait until being diagnosed with a serious illness to think about your wishes for care. In fact, making these choices when you’re healthy can reduce the burden on you and your loved ones later on. Talking about these issues ensures that when the time comes, you will face the end of your life with dignity and with treatment that reflects your values.

Talk to your doctor, nurse, or social worker for advice or help with filling out advance directives. Most health care facilities have someone who can help. As you prepare your advance directives, you should talk about your decisions with family members and loved ones and explain the reasons behind your choices.

It's hard to talk about these issues. But the benefits of talking to the people close to you about the kind of care you want are:

• Your wishes are known and can be followed.
• It often comforts family members to know what you want.
• It saves family members from having to bring up the subject themselves.
• You may also gain peace of mind. You are making the choices for yourself instead of leaving them to your loved ones.
• It can help you and your loved ones worry less about the future and live each day to the fullest.

If talking with your family and other loved ones is too hard, consider having a family meeting and invite a social worker or member of the faith community to guide the discussion. For more details on making these decisions, see the National Institute on Aging's page, Advance Care Planning. 

What Should I Do with My Advance Directives?

Once your advance directives have been completed, the next steps are:

• Review them with your doctor or other member of your health care team for accuracy before signing. Most states require a witness to be present at the signing of the documents.
• Give copies to your doctor, hospital, and family members after you sign them.
• Store copies in a safe place that's easy to access.
• Consider keeping a card in your wallet with a written statement that says you have a living will and durable power of attorney for health care and describe where the documents can be found.

Some organizations will store advance directives and make them available on the patient’s behalf. See the National Hospice and Palliative Care Organization page for more information about companies that provide this service.

Can I Change My Advance Directives?

Even after advance directives have been signed, you can change your mind at any time. As a matter of fact, the process of discussing advance directives should be ongoing, rather than taking place just once. This way you can review the documents from time to time and modify them if your situation or wishes change.

To update your document, you should talk to your doctor and loved ones about the new decisions you would like to make. When new advance directives have been signed, the old ones should be destroyed.

Are There State Laws for Advance Directives?

Each state has its own laws regarding advance directives. Therefore, special care should be taken to follow the laws of the state where you live or are being treated. A living will or durable power of attorney that is accepted in one state may not be accepted in another state. State-specific advance directives can be downloaded from the National Hospice and Palliative Care Organization.

More Information about Advance Directives

The Five Wishes Program

The Five Wishes is an advance care planning program created by the non-profit organization Aging with Dignity, with help from the American Bar Association, to help define how you wish to be cared for.

The Five Wishes workbook is an easy-to-read living will available in digital and paper version. The digital version is legal in all 50 states and the District of Columbia. The paper version is available in 30 languages and is legal in all 50 states, but you may need to take extra steps to complete the process if you live in New Hampshire, Kansas, Ohio, or Texas.

The Five Wishes Program also offers an advance care planning guide for adolescents and young adults called Voicing My Choices, and one for children called My Wishes. Both are available in English and Spanish. These, and other resources, can be accessed online or ordered in hard copy format.

Website: fivewishes.org
Email: Info@fivewishes.org
Phone: (850) 681-2010

National Hospice and Palliative Care Organization

The National Hospice and Palliative Care Organization (NHPCO) represents programs and professionals that provide hospice and palliative care in the United States. CaringInfo is a national consumer and community engagement program of NHPCO that works to improve care at the end of life. CaringInfo provides a toll-free number, website, and a wide range of free materials about end-of-life care (such as hospice and palliative care information, advance care planning, and caregiving). It also provides free advance directives with instructions for each state. Some Spanish-language publications are available, and staff can answer calls in Spanish.

Website: www.caringinfo.org
Helpline: 800–658–8898
Multilingual helpline: 877–658–8896
Email: caringinfo@nhpco.org