What is an Advance Directive and Should I Have One?

A. An advance directive states your wishes for health care decisions if you become incapacitated and is generally a good idea to have.

An advance directive will set forth your health care choices for your doctors and loved ones to follow when you cannot speak for yourself. These instruments can be as basic as a “do not resuscitate” order or can be more detailed.

In most instances, advance care directives are intended to prevent overaggressive care at the end of your life that is aimed at keeping you alive. You may decide that you do not want healthcare providers to take all measures possible to save your life at a certain point. Just know that your advance care directive is binding and will have to be followed, so be certain that your directive reflects your true wishes.

It is best to think years ahead of time when drafting your advance directive and not wait until closer to when you may need it. First, you never know when you may come incapacitated. You may experience an accident that may leave you without cognitive abilities. This is simply not a document that you can craft without your full faculties. Second, it is best to be able to have a full conversation with your loved ones to let them know what your desires are and discuss how this advance directive would work in practice.

When it comes to the living will, it is more than simply having the DNR order. You can also have the living will state whether or not you wish to be fed with a tube in the event that you become unable to eat. The living will can include whether you wish to have dialysis if necessary or to be hooked up to a ventilator. You can also use this instrument to make your wishes known about palliative care.

In the nursing home setting, each facility is required to ask for any advance directives when admitting the resident. Staff must always follow the directives at all time, and there have been numerous instances in which nursing homes have been fined for not following these directives. In general, studies have shown that the presence of an advance care directive has reduced aggressive end-of-life care. Since many nursing home residents suffer from dementia, it is extremely important to timely plan for the medical care decisions before they reach that point.

In addition to a living will, an advance care directive can also include health care power of attorney. This is an incredibly critical document that states who will make healthcare decisions for you in case you cannot do so. This is important because families will often disagree over the proper decisions to make for their loved one when the time comes. Having one person who makes these decisions can not only make the decision making process more effective, but it can also increase family harmony. Absent this appointment, the court could appoint someone to make these healthcare elections, and it may not be who you want. When choosing someone to have this power of attorney, select someone who you know well and have a conversation with them ahead of time about your wishes.

There is little reason not to have an advance directive. It will take some of the strain off of your loved ones during a difficult time, and they will not be left to wonder what you would have wanted had you been fully able to express yourself. An attorney can help you draft this document and put it into practice since there are legal requirements that need to be met for advance directives.