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What are the advance directives for healthcare?

If you or a loved one have been hospitalized recently, you were probably asked to complete an advance directive, which generally includes naming a healthcare proxy. This can be jarring, as most of us associate advance directives with end-of-life care. At their most basic, advance directives are legal documents stating your wishes. Their job is to speak for you, in the event that you become unable to speak for yourself.

Having advance directives doesn’t mean you are going to die, and it doesn’t mean that you no longer get to make your own decisions. They are simply a way for your voice to be heard, even when you cannot speak for yourself. Likewise, your advance directives can be changed as your preferences change. They are not set in stone once and for all.

Generally speaking, advance directives are made up of two separate documents: a living will and a healthcare proxy (or durable power of attorney for healthcare).

A living will is where you document your healthcare preferences. This can be as general or as specific as you wish. Some people use their living will to describe the things most important to them. Other people wish to state specific preferences for specific medical scenarios. Commonly-addressed issues in living wills include artificial nutrition and hydration, the use of breathing tubes (respirators), attempts at resuscitation, and use of blood products.

Why should you have an advance directive? Because, in the event that you’re unable to speak for yourself, your healthcare team is going to ask your family what you would want done. An advance directive is a gift to them: a message in a bottle that helps them know that they are doing what you would want.

A healthcare proxy, or durable power of attorney for healthcare, is a way for you to stipulate exactly who you want to make decisions on your behalf, if you were unable to. Again, appointing a healthcare proxy does not mean that you no longer allowed to make decisions. It only means that, in the event that you are unable to speak for yourself, your healthcare team knows who you want to speak for you. Appointing someone specific helps everyone know what’s going on.
An advance care directive helps ensure that a person's health care wishes and end-of-life concerns are known and respected. Two common advance directives are:
  • a living will, which sets forth medical wishes that will guide health care if a person becomes mentally or physically unable to make decisions
  • a health care power of attorney or health care proxy form, which designates a person to act on an ill person's behalf when necessary.
Katrina Bramstedt, PhD
Health Education

An advance directive (also known as a living will) is a document in which you announce your personal values about life, health, healthcare, dying, suffering, and quality of life. In this document you can indicate the types of treatment you want as well as the types of treatment you dont want. You can also indicate other preferences such as where you want to die (at home vs hospital), if you want to be an organ donor, who you want to function as your proxy/surrogate decision-maker, etc.

You do not need an attorney to prepare a living will. Also, these documents apply only to your healthcare -- not to your personal finance matters (bank accounts, real estate, other assets).

If you would like a free living will template, visit my website, www.TransplantEthics.com and download the pdf file. When you have completed the document, give a copy to your personal physician and also to your surrogate decision-makers.

Overall, living wills are important documents because they guide the medical team to give you the medical care that you want and to not give you the treatments you don't want. 

Learn more by reading my book, Finding Your Way: A Medical Ethics Handbook for Patients and Families.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.