Table of Contents
- The Basics: What is an Advance Healthcare Directive?
- When Do I Need One?
- The Consequences of Not Using One
- Validating and Updating Your Advance Healthcare Directive
1. The Basics: What is an Advance Healthcare Directive?
An Advance Healthcare Directive is a collection of legal documents empowering you to spell out your end-of-life decisions and medical care if you become unable to communicate your wishes due to terminal illness or incapacity. The Advance Healthcare Directive is made up of two primary legal documents:
Both documents are often accompanied by secondary documents providing for, or defining in greater detail, matters not covered by them.
- Documents addressing matters of comfort and palliative care, including personal hygiene and grooming
- Recommendations addressing religious considerations for memorial and funeral plans
At minimum, you are encouraged to complete a Living Will and Medical Power of Attorney to establish a comprehensive framework for your end-of-life healthcare decisions.
With this Directive, your healthcare providers and loved ones will be informed about your preferences regarding:
- End-of-life decisions
- Life-sustaining medical treatment
- Organ and tissue donation
- The appointment of a healthcare agent
- Your healthcare agent’s authority
Think of an Advance Healthcare Directive as a puzzle, with a Living Will and Medical Power of Attorney representing individual puzzle pieces.
What is a Living Will and Medical Power of Attorney? And Why Do I Need Both?
A Living Will is the oldest form of an Advance Healthcare Directive and allows an individual to describe specific healthcare directives and medical wishes to healthcare providers and caregivers should they become incapacitated or unable to communicate. Dissimilar to a Last Will and Testament, a Living Will becomes effective while you are still alive, but unable to communicate your healthcare wishes.It will address such matters as:
- Pain relief
- Use of Cardiopulmonary resuscitation
Medical Power of Attorney (MPOA)
An MPOA allows you to designate a healthcare agent, or proxy, to make healthcare and medical decisions for you if you are unable to communicate. Your agent is able to speak to doctors and caregivers in real time, adapting to the situation at hand. If your wishes in a specific healthcare situation are not provided for in your Living Will, your agent will use their discretion, based on your past healthcare directions, to decide what they think you would want.
Why You Need Both
Compared to a Medical Power of Attorney, a Living Will is much more limited in scope, as it only provides control over a finite list of anticipated directives, treatments, and medical situations. There is a chance that an unanticipated diagnosis, surgery, treatment, or other medical situation arises, and you have failed to anticipate and provide for it in your Living Will.
A Medical Power of Attorney is more flexible and versatile. It allows you to appoint a healthcare agent, who adapts to real time changes and unanticipated events, using their discretion to best resolve an issue in a manner they think you would have chosen. An MPOA can be viewed as a safety net for issues you failed to anticipate in your Living Will.
Both of these documents are important and should be used jointly, to ensure you protect yourself, your loved ones, and healthcare provider from any confusion over end-of-life or other healthcare issues.
An Advance Healthcare Directive may also be called:
- Personal directive
- Advance directive
- Medical directive
- Advance decision
- Advance medical directive
The Differences Between a Living Will and Medical Power of Attorney:
Medical Power of Attorney
|Control over your future healthcare decisions||Control over your future healthcare decisions|
|Delineates your healthcare wishes specifically and does not appoint an agent to make healthcare decisions on your behalf||Allows you to appoint an agent to make healthcare decisions on your behalf|
|Must be at least 18 years of age and of sound mind||Must be at least 18 years of age and of sound mind|
|Limited to deathbed concerns only||Covers all healthcare decisions|
|Anticipates hypothetical medical and healthcare situations||Allows your agent or proxy to make real-time decisions based on the actual circumstances|
|Used to declare your desire not to have life-prolonging measures taken if there is no chance of recovery||Lasts only as long as you are incapable of communicating and making healthcare decisions for yourself|
|Trumps Medical Power of Attorney if there is conflict||Allows your agent to fill in gaps that weren’t addressed in your Living Will|
Keep in mind that choosing not to have aggressive medical treatment is different from refusing all medical care. You can still opt to receive antibiotics, pain medicines, nutrition, and other treatments.
A comprehensive Advanced Healthcare Directive should have the following clearly spelled out:
- Healthcare agent/proxy: A designated person with legal authority to make healthcare decisions on your behalf when you are no longer able to communicate
- Scope of authority: When your agent’s authority becomes effective, and what decisions they are authorized to make regarding your healthcare and medical treatments
- End-of-life decisions: In case of terminal illness or incapacitation, end-of-life decisions are your wishes and values regarding how your agent and healthcare providers should proceed based on legal, medical, sociological, and theological considerations
- End-of-life terminology defined: Defining important end-of-life medical terms and clarifying possible confusion over meaning and interpretation. For example, deciding a reasonable and clear definition of terms such as “terminally ill,” “brain dead,” or “permanently unconscious”
- Life-sustaining medical treatment: The life-sustaining procedures and treatment you want performed on you to restore function to any organ; including, resuscitation, dialysis, antibiotics, mechanical ventilation, and artificially administered water and food
- Organ donation: Whether you want to donate your organs, tissues, or body for transplantation or medical research
- Witnesses: To have legal validity, you must generally have two witnesses or a notary present when signing your Advance Healthcare Directive
Make sure your appointed healthcare agent is someone you can trust and can keep a “cool head.” Oftentimes they will need to make decisions under times of great stress, sadness, and uncertainty.
What Does a Comprehensive Advance Healthcare Directive Look Like?
An Advance Healthcare Directive should include a Living Will and Medical Power of Attorney. It is recommended to include supplementary documents addressing matters in not addressed in either document or in greater detail. The most popular and comprehensive type is the “Five Wishes Directive,” created by non-profit organization Aging with Dignity.
The “Five Wishes” Advance Healthcare Directive has been referred to as a “Living Will with a heart and soul,” because it address legal, medical, sociological, theological, and administrative considerations regarding healthcare, along with unique intangibles such as comfort care, forgiveness, spirituality, and final wishes.
The “Five Wishes” Directive is comprised of:
Wish 1: Medical Power of Attorney
A Medical Power of Attorney, appointing who will make medical decisions for you if you have a terminal illness or are unable to communicate
Wish 2: Living Will
A Living Will, spelling out your end-of-life decisions concerning medical treatment and other healthcare directives
Wish 3: Comfort and Palliative Care
Secondary documents addressing matters of comfort (palliative) care – specifically, the type of pain management you prefer, personal grooming and hygiene instructions, and hospice care
Wish 4: Personal preferences
Secondary documents addressing personal matters and preferences, such as whether you would like to be at home during medical treatment, or have someone pray at your bedside
Wish 5: Post-mortem considerations
Secondary documents and recommendations addressing matters of forgiveness, memorial and funeral plans, and how you would like to be remembered and celebrated
According to an analysis by the American Bar Association Commission on Law and Aging, the “5 Wishes” directive meets the legal requirements for an Advance Directive in 42 states, including Washington D.C., excluding Alabama, Indiana, Kansas, New Hampshire, Ohio, Oregon, Texas, and Utah.
Advance Healthcare Directive PDF Sample
The sample advance healthcare directive below details an agreement between the principal, ‘Michelle R Kane’, and the healthcare agent, ‘William S Bryan.’ The two agree on the powers that William S Bryan will have as Michelle R Kane’s healthcare agent and when his powers will be effective.Universal Power of Attorney (Medical)
2. When Do I Need One
You should create an Advance Healthcare Directive if you want control and peace of mind over your future healthcare decisions. Your Directive will alleviate stress and confusion amongst healthcare professionals and your loved ones.
I should create an Advance Healthcare Directive if I am…
- Over the age of 18 years old
- Military personnel being deployed overseas
- Married and want to pass legal authority over property to my spouse
- Concerned about informing my loved ones and healthcare providers of my preferences regarding life support, resuscitation, ventilators, feeding tubes, and pain management
- Traveling abroad for a length period of time
- Undergoing surgery, however minor or routine it is
- Entering the hospital for any reason
- Diagnosed with a terminal illness
- Undergoing continuous medical treatment
- Concerned about my health
- Engaged in a high risk profession (police officer, firefighter, logger, minor, aircraft pilot, roofer, etc…)
- Engage in extreme sports or other activities that put my health at risk
Florida state law does not give healthcare directive authority automatically to your spouse, but to your court appointed guardian. If you are a spouse, brush up on your state’s law to make sure whether you are given priority and authority over your spouse’s healthcare wishes.
7 Important Questions to Consider When Creating Your Advance Healthcare Directive
- Whom do you wish to make healthcare and financial decisions for you should you become unable to communicate?
- Which medical treatments do you want to receive and which ones are out of the question?
- Do you want to be resuscitated if your heart stops beating or if you stop breathing?
- If you fall terminally ill or become incapacitated, do you want to be cared for at home or at the hospital?
- How will your medical care be paid for?
- Have you overlooked anything that will be potentially costly and a financial burden on your loved ones?
- Do you have sufficient insurance coverage?
In 2009, then President, Barack Obama, became the first president of the United States to publicly announce he had a Living Will, encouraging others to follow suit.
3. The Consequences of Not Using One
Without an Advance Healthcare Directive, you risk your healthcare provider and loved ones not knowing your healthcare preferences and how best to accomplish them. Your primary-care physician or wife, could have conflicting views on what should be done in certain medical situations, leading to highly contentious and confusing circumstances, possibly putting your life at stake.
A Living Will coupled with a Medical Power of Attorney gives you the opportunity to take control of your future in case of medical emergency and uncertainty.
Having a clear and thorough Advance Healthcare Directive can help ensure the following benefits, and prevent these consequences:
|Right to self-determination, the process by which you control your own life||Confusion over your healthcare wishes|
|Ensuring the quality of life that is important to you, while avoiding treatments that may be lethal||Unnecessary, unwanted, prolonged or painful treatments|
|Alleviates pressure, confusion, and financial hardship for your loved ones and healthcare providers||Substantial healthcare maintenance costs|
|Clarifying any highly contentious medical issues that could arise amongst your family and other loved ones||Emotionally taxing on your loved ones|
|Provides your doctors with a blueprint on how to treat you||Organs and tissue not being donated|
Cost burdens associated with end-of-life care and treatment can be substantial. An estimated 20% of cases require a family member to quit their job, 31% claim to have lost most or all of their savings, and 20% reported a major loss of their source of income. All of these hardships were incurred even with insurance.
With the growing complexity of today’s medical conditions and life-extending treatments, you are never too young, nor too healthy to start drafting your Advance Healthcare Directive.
The Case of Terri Schiavo
From 1990 to 2005, the U.S. was gripped by famous right-to-die legal case involving Terri Schiavo, her parents, and her husband, Michael Schiavo. After slipping into an irreversible vegetative state, Terri’s parents and husband entered into a highly publicized and prolonged legal battle over what her healthcare wishes would have been.
Because she had no Living Will or written instructions, there was disagreement over whether to keep Terri alive, or remove her from life support. Terri’s parents argued in favor of keeping her alive via artificial nutrition and hydration, denying the medical diagnosis, while Michael sought to have her removed from the feeding. The Schiavo saga involved 14 legal appeals on top of numerous petitions, motions, and hearings, with her feeding tube finally removed after 15 years.
An unclear and incomplete Advance Healthcare Directive can mean the difference between life and death.
A Curious Case of Medical Error and an Unclear Directive
With medical error as the third leading cause of death in the United States, make sure your Advance Healthcare Directive is clear and can adapt to changing circumstances. Misinterpretations of end-of-life documents commonly result in unexpected death or unwanted, aggressive medical treatment. Medical staff oftentimes has merely seconds or minutes to act.
Mary Jo Estep, a survivor of what is considered the nation’s last massacre of Native Americans, is an unfortunate example of how an unclear and ambiguous Advance Healthcare Directive can lead to confusion, and ultimately death.
After breaking her hip, Estep checked herself into rehab at a nursing home. While in rehab, she signed a Living Will, stating she would not receive extraordinary measures if she was dying. A few days before returning home, an exhausted nurse gave Estep the wrong medication. The effects of the medication were easily reversible, but due to Estep’s poorly worded Living Will, the doctor interpreted it to mean she would not want any treatment. She passed away soon after.
4. Validating and Updating Your Advance Healthcare Directive
When you’ve completed your Advance Healthcare Directive, there are a few steps you will need to take to make it valid.
- Witnesses: Depending on who witnesses your signature, some states require you to have your directive notarized in order to give it legal effect
- Notify your healthcare provider: Provide your healthcare proxy or agent, primary-care physician, hospital, trusted individuals, and anyone named in the directive with copies
- Storage: Keep your original directive in a safe place, such as a safety deposit box
Once your Advance Healthcare Directive has been created, it isn’t set in stone. Your opinions and values regarding your future healthcare needs could possibly change, so your directive should reflect those changes. You should reassess and consider changes to your Advance Healthcare Directive anytime one of the following “Five Ds” occurs.
The Five D’s of Updating Your Directive
The Five D's
|Diagnosis||When you are diagnosed with a serious or grave health condition|
|Decline||When you experience a significant deterioration or decline in health|
|Death||Whenever you experience the passing of a loved one|
|Divorce||When you experience a divorce or other significant family change|
|Decade||When you enter a new decade of your life|
EMTs Likely Won’t Honor Your Directive
You should keep in mind that Emergency Medical Technicians (EMTs), are not required to honor your Living Will or Medical Power of Attorney. Once an emergency call has been made, their job requires them to do whatever is necessary to stabilize a person for transportation to the hospital.
Your Advance Healthcare Directive comes into effect only after a hospital physician has evaluated your condition thoroughly and determined your underlying conditions. Some states recognize a special out-of-hospital “Do not resuscitate” bracelet, which could help prevent emergency personnel from ignoring your Advance Healthcare Directive.