What is an Advance Directive and Why is it Important?
Imagine a moment when you can no longer voice your healthcare decisions. Who speaks for you? What choices would they make? As a hospice case manager, I’ve stood at the bedside as families navigate these difficult questions, witnessing firsthand the emotional weight of uncertainty when a loved one’s wishes remain unspoken.
It’s never too early to have an advance directive in place, as it is a part of your healthcare planning. Advance directive planning is similar to planning any special event in your life. For example, wedding planning. You have to choose a venue, music, food, and more. Directive planning is the same way.
The purpose is to ensure you receive the treatments you want when you are unable to make those decisions for yourself. Without this legal form, your state can determine who makes your healthcare decisions for you. This blog will explore the different types of directives, their meanings, and resources to help guide your journey.
What is an advance directive?
An advance directive is a legal document that outlines a person’s medical care preferences when they can no longer communicate their wishes. Some individuals start directive planning when they are healthy and competent, while others begin this process after being diagnosed with a terminal illness. There are several different types of advance directives, such as:
A Living Will: A legal document that informs healthcare professionals how you would want to be treated if you can no longer speak for yourself. For example, if you do not want to be intubated, your living will specify this, and the medical team will honor it.
A Durable Power of Attorney: A person who can make medical decisions on your behalf, also known as a healthcare surrogate. Ensure the person you appoint for this role understands your wishes and values.
Do Not Resuscitate: This order instructs healthcare providers not to perform CPR or other life-saving measures if your heart stops or you stop breathing.
Do Not be Hospitalized: This directive informs your healthcare team that you do not wish to be admitted for life-sustaining treatment at the end of life.
Provider order for life-sustaining treatment (POLST): A portable order that allows seriously ill patients to specify their treatment preferences, such as certain medications, nutrition, and cardiopulmonary resuscitation.
Advance directives are important because they ensure your wishes are being respected and reduce the emotional burden on your family. It also guarantees your healthcare will align with your values and preferences. Advance directives significantly reduce the emotional strain on your family by providing clear guidance and eliminating the need for difficult guesswork.
POLST vs Living will: What’s the difference?
Let’s further discuss the key differences between provider orders for life-sustaining treatment and living wills. A POLST is a portable medical order that provides highly specific instructions for those who have life-limiting conditions. In contrast, a living will is legal paperwork outlining future healthcare wishes. For example, a living will may specify treatments such as CPR or a healthcare surrogate to make decisions for the patient. Lastly, a living will is for all adults, whereas the POLST is for terminally ill patients only.
Misconceptions about advance directives
Misconceptions around advance directives may lead to late or no planning. Many think it is only for the elderly or people with a terminal illness. These are all common misconceptions about directives. The earlier you plan, the better the outcome is for you and your family. As a hospice case manager, I worked closely with the social worker to ensure our patients have a living will so their end-of-life care is carried out. If there isn’t a legal paper in place, we work with the patient and family to get one.
Some common myths around advance directives:
Advance directives mean “do not treat”.
Advance directives are only for older adults.
Once completed, you can not make changes to your advance directives.
Advance directives are only for the terminally ill and not for healthy individuals.
Advance directives mean you are giving up on life.
My family can override my wishes when I can’t speak for myself.
Anyone over the age of 18 should have an advance directive in place because unexpected life events can occur at any time. Look at directives as your second voice when you can’t communicate your needs. No one can override your directive once signed by your doctor but you. It is a legal statement that everyone must follow. Most importantly, advance directives guarantee that your desires are acknowledged. Please don’t wait and start planning today.
A guide to creating an advance directive
Advance directives acknowledge your wishes and serve as a legal document for families and healthcare professionals to adhere to. Here are five steps to create one:
Explore your wishes: You can discuss your desires with your loved ones or a healthcare provider. Ask yourself, “ Would I want to be resuscitated when my heart stops or have a feeding tube when I can no longer eat by mouth”?
Get your state form: Living will paperwork is free and available online without the need for a lawyer. Of course, you can use one if you need to. You can also visit your health department website for more information, as each state has specific requirements.
Complete the form: Clearly state your medical preferences for life-sustaining measures. If you choose a healthcare proxy, ensure it’s someone you can trust to advocate for you. * A healthcare proxy is someone you appoint to make your healthcare decisions for you.
Legalize it: Signing and dating your advance directive officially validates the document. It’s crucial to understand your state’s laws regarding witness signatures and notarization, as these may be necessary for your directive to be legally binding.
Update as necessary: It’s essential to review your directive every couple of years or after a change in your health. As we get older, our wishes may change, and that’s okay. Make sure you update your directive by completing a new one and discarding the old one. Share copies with your loved ones and doctor so they are aware of your wishes.
For additional resources, you can also visit the AARP Advance Directive tool and the National Hospice and Palliative Care Organization.
Don’t wait to begin your advance directive planning
An advance directive consists of steps you can take for yourself. It ensures your healthcare wishes are carried out when you are unable to communicate for yourself. Having this legal document in place may also reduce stress and uncertainty in your family because they don’t have to guess your treatment preferences. Advance directives are more than end-of-life; it’s about peace of mind and dignity. Plan now and make your wishes known; it’s never too early to start an advance directive.
FAQ
What is the difference between a DNR and an advance directive?
A do-not-resuscitate (DNR) order states that you do not want cardiopulmonary resuscitation (CPR) if your heart stops beating or you stop breathing. An advance directive is a legal statement that specifies your wishes about your care when you cannot speak for yourself.
2. What is an example of an advance directive?
One example of an advance directive is as follows: “If I am unable to tolerate food by mouth due to a terminal condition, I do not want artificial nutrition such as feeding tubes to sustain my life. Instead, I would like to receive palliative care to keep me comfortable.”
3. Can a family member override a patient’s wishes in their advance directive?
No, family members can not override a patient's wishes in their advance directives. It is a legal document that validates the patient's treatment preferences.
