Advance Directives and Planning Ahead

What advance directives areExplain▾

Advance directives are legal papers that tell your loved ones and doctors what kind of medical care you want if you cannot 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 care you would want. All adults should have advance directives. It is best to fill them out when you are healthy, in case you become ill or unable to make these decisions in the future.

The two main typesExplain▾

There are two main types of advance directives.

A living will is a document used to state whether or not you would like to receive certain types of medical care if you become unable to speak for yourself. The most common types of care it addresses are:

• the use of machines to keep you alive, such as dialysis machines and ventilators (also called respirators)
• "do not resuscitate" (DNR) orders, which instruct the health care team not to use CPR if your breathing or heartbeat stops
• tube feeding
• withholding food and fluids
• organ and tissue donation

A durable power of attorney for health care is a document that lets you name another person to make decisions about your medical care if you are unable to make them yourself. It is also called a health care proxy or medical power of attorney. People often appoint someone they know well and trust. This person may be called a health care agent, surrogate, or proxy.

Why they matterExplain▾

Filling out advance directives gives you control over your health care. Choices about end-of-life care can be hard to make even when you are healthy, and if you are already seriously ill they can feel overwhelming.

Some people want to try every drug or treatment; others choose to stop treatment. Although you may turn to family and friends for advice, ultimately it is your decision.

It is important to remember that even if you choose to stop treatment aimed at your disease, care to promote your well-being continues. This palliative care includes treatment to manage pain and other symptoms, plus support for emotional and spiritual needs.

When to fill them outExplain▾

Ideally, these documents should be completed when you are healthy. Many people connect advance directives with decisions near the end of life, but you do not need to wait until a serious diagnosis to think about your wishes. Making these choices while healthy can reduce the burden on you and your loved ones later.

Talk to your doctor, nurse, or social worker for help filling them out. Most health care facilities have someone who can assist. As you prepare, talk about your decisions with family members and explain the reasons behind your choices. The benefits of talking include:

• your wishes are known and can be followed
• it often comforts family members to know what you want
• it saves family from having to bring up the subject themselves
• you may gain peace of mind
• it can help everyone worry less and live each day more fully

If talking with family is too hard, consider a family meeting with a social worker or member of your faith community to guide the discussion.

After you complete themExplain▾

Once your advance directives are done, review them with your doctor for accuracy before signing. Most states require a witness at the signing. Then:

• give copies to your doctor, hospital, and family members
• store copies in a safe place that is easy to access
• consider keeping a card in your wallet stating that you have these documents and where they can be found

Some organizations will store advance directives and make them available on your behalf.

Changing them and state lawsExplain▾

Even after advance directives have been signed, you can change your mind at any time. In fact, the process should be ongoing rather than a one-time event. Review your documents from time to time and update them if your situation or wishes change. When new directives are signed, the old ones should be destroyed.

Each state has its own laws about advance directives. A living will or durable power of attorney accepted in one state may not be accepted in another, so follow the laws of the state where you live or are being treated. State-specific forms can be downloaded from organizations such as the National Hospice and Palliative Care Organization.