Nobody particularly likes thinking about death, but it presents a lot of questions that need to be answered, especially when it comes to how you or your loved ones want to be treated near the end of your life. You might think that you’ll be fine leaving it to the decisions of your doctors or your family members, but sometimes you need to set clear guidelines for how to handle these important health care considerations.
In these situations, it is important to invest some time to develop an advance health care directive.
Understanding Advance Healthcare Directives
An advance healthcare directive (often just called an advance directive) is a legal document that explains how you want medical decisions about you to be made if you cannot make the decisions yourself.1 Since there are several injuries, illnesses, and psychiatric conditions that may leave you unable to make medical decisions, an advance directive allows you to fill out exact instructions on how to handle your health care in the event you are unable to do so.
There are two primary types of advance directives: a living will and a power of attorney.
A living will is the oldest form of an advance directive and the form that is most commonly associated with the term. It usually provides directives regarding the course of treatment that both healthcare providers and caregivers are expected to follow if you are dying or permanently unconscious and cannot make your own decisions about emergency treatment.2 This includes any procedures you would or would not like to be performed on you.3 However, the living will is only acted upon if the person in question is unable to speak
A power of attorney (or POA) authorizes you to designate an agent to make important decisions on your behalf.4 Though this typically only includes financial decisions, you can establish a medical POA (sometimes called a health care proxy), which grants your agent the authority to make healthcare decisions as well. With a standard POA, the authority it grants ends when the principal is deemed incapable of making decisions for themselves. However, a medical POA is usually considered a durable power of attorney (DPOA), which means that the document remains in effect even if the principal is mentally incapacitated and unable to handle matters on their own.5
It is worth noting that while you can choose to have just a living will or just a medical POA, it is generally a good idea to have both. Doing so will ensure that you have someone assigned to make well-considered decisions for you while also guaranteeing that they follow your exact instructions on certain matters. There are also a few additional advance care planning documents that you should consider alongside a living will and a POA. Some common examples include:6
- DNR (Not Resuscitate Order) Order: Tells medical staff that you do not want them to revive you if your heart stops or is beating unsustainably during CPR.
- DNI (Do No Intubate) Order: Tells medical staff that you do not want to be put on a breathing machine.
- Organ & Tissue Donation Forms: Gives permission to donate healthy organs or body parts to another patient in the event of your death.
- Brain Donation Form: Gives permission to have your brain donated to scientific research.
- POLST and MOLST Forms: POLST (Physician Orders for Life-Sustaining Treatment) and MOLST (Medical Orders for Life-Sustaining Treatment) forms provide medical care guidance in the form of a doctor’s orders.
Factors to Consider with a Living Will
If you have any exact preferences in terms of end-of-life care, you should include them in your living will. Even if you have a medical POA and thoroughly trust your agent, you have no guarantee that they will follow your exact wishes unless you put it in writing. There are many different factors to consider when writing a living will:
- Cardiopulmonary resuscitation (CPR)
- Mechanical Ventilation
- Tube Feeding
- Antibiotics / Antiviral Medications
- Palliative Care
- DNR / DNI Orders
- Organ and Tissue Donations
- Donating Your Body
You should also consider if you want life support to be removed if you are found to be irreversibly brain dead, along with how you want your body to be disposed of after death.
In the end, everyone deserves to have control over how they live their lives, and how they spend their final days. An advance healthcare directive gives you control over your final moments, establishing clear guidelines to ensure that your wishes are followed.
1. American Cancer Society. (n.d.). What Is an Advance Directive? American Cancer Society. https://www.cancer.org/treatment/finding-and-paying-for-treatment/understanding-financial-and-legal-matters/advance-directives/what-is-an-advance-health-care-directive.html.
2. U.S. Department of Health and Human Services. (n.d.). Advance Care Planning: Health Care Directives. National Institute on Aging. https://www.nia.nih.gov/health/advance-care-planning-health-care-directives.
3. Advance Directives: Healthcare Proxy, Living Will, POA. Hospital for Special Surgery. (n.d.). https://www.hss.edu/advance-directives.asp.
4. Kagan, J. (2021, May 19). Power of Attorney: Allowing One Person to Act on Behalf of Another. Investopedia. https://www.investopedia.com/terms/p/powerofattorney.asp.
5. Irving, S. (2020, August 11). The Durable Power of Attorney: Health Care and Finances. NOLO. https://www.nolo.com/legal-encyclopedia/durable-power-of-attorney-health-finances-29579.html.
6. U.S. Department of Health and Human Services.