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An advance directive is a written statement
about the kinds of
medical treatment you do or do not want
if you become unable
to communicate. |
As a patient, you have the right to make your own decisions about your health care. You also have the right to expect that your decisions will be honored. But if an unexpected disease or illness prevents you from communicating, how will your doctor and loved ones know your wishes for care and treatment?
One way to make sure your wishes are followed is to prepare an advance directive. An advance directive is a written statement about the kinds of medical treatment you do or do not want if you become unable to communicate. Although they vary from state to state, there are basically three types of advance directives.
Medical power of attorney
When you become unable to communicate, the authority to make decisions on your behalf falls to your closest relatives, usually your spouse or, if you are unmarried or your spouse has died, your children or parents. However, you may want a particular family member or other person to make these decisions. By completing and signing a form for medical power of attorney, also known as health care proxy or durable power of attorney for health care, you can appoint someone whom you know and trust to make decisions for you if you become unable to do so. This person, referred to as your agent, has the same decision-making power as you would have: he or she may agree to or refuse medical treatment or life support on your behalf.
You can limit your agent’s decision-making authority. For example, you may say that you wish to receive certain medications or treatments. You can also say whether you want to be treated by a certain physician or at a particular hospital. Your agent is obligated to follow your guidelines. Even after you have appointed an agent, you still have the power to make decisions about your care. You can take away your agent’s authority at any time, either orally or in writing, regardless of whether you are considered competent. If you designate your spouse as your agent, his or her decision-making authority will be revoked if you get a divorce unless you state otherwise on the form.
Living will
A living will, also known as a directive to physicians and family or surrogates, is a legal document that describes the kinds of treatments you want if you become terminally ill. A living will does not designate a person to make health care decisions for you; instead, it gives doctors instructions for how to treat you if you cannot tell them yourself. For example, you can use a living will to let your doctor know that you do not want to receive artificial nourishment (tube feeding). A living will takes effect only when you are receiving end-of-life care.
Limitations to medical powers of attorney and living wills
Although medical power of attorney gives decision-making authority to one person, it does not tell that person explicitly what to do in every possible situation. Similarly, while a living will can give your doctors and loved ones an idea of what you want, it does not specify what should be done in every possible situation. One approach is to set up both medical power of attorney and a living will. This way, your agent can make decisions for you based on what you have stipulated in your living will.
Do-not-resuscitate orders
If you stop breathing or your heart stops, health care providers are obligated to do everything medically possible to help you. But if you feel that resuscitation would only leave you permanently incapacitated, you may choose to have a do-not-resuscitate order (DNR). A DNR is a form signed by your doctor that allows you to refuse CPR or other life-sustaining treatments if you stop breathing or your heart stops.
Preparing advance directives
Anyone age 18 years or older can prepare an advance directive. Advance directives do not have to be complicated legal documents—they do not even have to be written by an attorney. However, to be valid, they must comply with your state’s laws. All advance directives should be signed, witnessed, and notarized. Often, you can obtain the appropriate forms from your physician or hospital. You can also contact your state’s health department to obtain the necessary forms, or simply write your wishes down yourself. Always be sure to discuss your wishes with your family and health care providers and provide them with copies of your advance directives.
Preparing an advance directive will help you have conversations about life, health, and death from a realistic perspective. These conversations will reduce the burden of decision-making for your loved ones during difficult times.
- J. Munch
For more information about advance directives, as well as forms for medical powers of attorney and living wills, are available through M. D. Anderson’s Department of Social Work.
Other articles in OncoLog, September 2008 issue:
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