GUIDE TO ADVANCE DIRECTIVES

GUIDE TO ADVANCE DIRECTIVES

Thinking about the kind of medical care you would choose in life—or—death situations can be uncomfortable. The questions that arise are difficult: Would you want to be kept alive with the help of a respirator, for example? If you were terminally ill and near death, would you choose to be resuscitated if your heart stopped beating? What medical treatment would you choose if you had a stroke that left you completely dependent upon other people?

While difficult, experts say it’s important to answer these questions, and share your answers with others, so you get the kind of care you want in such situations—even if you’re unable to communicate.

The best way to ensure you get the kind of care that reflects your choices and values is to do some advance care planning and prepare an “advanced directive.” An advance directive lets doctors and others know what kind of treatment you do and don’t want. If you’re ever too sick to make decisions for yourself, your advance directive will let others know what kind of medical care you want.

The ideal advance directive includes two parts—a “durable power of attorney for healthcare: (DPAHC) and a “living” will.”

•A durable power of attorney for health care (DPAHC) names the person you want to make treatment decisions on your behalf if you’re unable to make these decisions yourself. This person—known as a “surrogate” or “advocate”—is typically a relative or close friend. Before you prepare a DPAHC, you should make sure he or she is willing to make such decisions on your behalf. You should also specify what kind of medical care you do and don’t want (see “living will,” below, for more). In addition, if you want your advocate to be able to refuse care that’s needed to keep you alive, you must put this in writing in your DPAHC.

•A living will tells your advocate, physicians and other healthcare professionals what kind of medical treatment and care you would and wouldn’t want. Among other things, you may choose to specify in your living will that you always want the best possible “palliative” care—care designed to keep you as comfortable as possible.

Healthcare providers will rely on your advance directive for guidance only when you are no longer able to make decisions about and tell them what kind of care you want. As long as you and your healthcare provider agree that you are able to make decisions about your treatment yourself, you will be able to do so.

Preparing an advance directive doesn’t have to be complicated You don’t need a lawyer, but you can choose to have a lawyer help you. Different states have different laws concerning advance directives and you can find free DPAHC and living will forms for your state on the National Hospice and Palliative Care Organization Website. www.nhpco.org. Just follow the instructions accompanying the forms to complete them. The best forms describe different medical situations, such as being in a coma, and list care options for each; you simply check the options you want.

These tips can also help you prepare an advance directive: 

Talk to your relatives, friends, and healthcare providers and give them copies of your advance directive. Explain your wishes so your family, friends, and providers understand and are prepared. It’s a good idea to make multiple copies of your advance directive and given them to your doctor, hospital, and loved ones. A copy should go into your medical record.

Keep a copy. Put another copy of your advance directive in a safe, easy-to-find place, and let your loved ones know where it is. You may also want to put a note in your wallet explaining that you have an advance directive and where it can be found.

Review and revise your advance directive as needed. Advance directives do not expire. An advance directive remains in effect until you change it. If you complete a new advance directive, it invalidates the previous one. Over time, you may change your mind about what kinds of treatment you would, and wouldn’t, want. If you do, you should revise your advance director and give everyone a copy of the new version.

Foundation for Health in Aging Established by the American Geriatrics Society 350 Fifth Avenue Suite 801 New York, NY 10118 212-755-6810 www.healthinaging.org The Foundation for Health in Aging builds a bridge between the research and practice of geriatrics healthcare professionals and the public. The Foundation advocates on behalf of older adults and their special needs through public education, clinical research, and public policy. The American Geriatrics Society is dedicated to improving the health and well-being of older adults. With a membership of over 6,000 healthcare professionals, the AGS has a long history of improving the healthcare of older adults.