What Is an Advance Directive?
An advance health care directive usually consists of two essential components that can be incorporated into one document. One component is a directive on the treatments you desire and don’t desire. This part is also commonly referred to as a living will. The other component is a medical power of attorney, which names an agent to act on your behalf when you are hospitalized and incapacitated.
The advance directive can be modified or revoked at any time. To create or modify an advance directive, you must be “competent,” meaning you have the mental and emotional capacity to know what you’re doing, but competency is not required to revoke the document. You can end it at any time.
In the directive or “living will” portion of the document, you can state your preferences for treatments you desire and for treatments you wish to be withheld. You can specify your decisions “yes or no” on:
- The use of equipment such as dialysis machines for your kidneys or ventilators to help you breathe
- The use of CPR if your heart or breathing stops – known as “do not resuscitate” if you choose not to have CPR applied
- Foods or liquids supplied through an IV or tube in your stomach should you be unable to eat
- Treatment for pain, suffering, nausea, or anxiety through drugs (comfort or palliative care)
- Donation of your organs after death
- Whether you want a burial or cremation
Choosing a Health Agent
The other vital component of the advance directive, in addition to your expressed desires, is naming an agent to carry out your decisions for you. The agent should be someone you trust implicitly to honor your wishes, whether it be a spouse, family member, or trusted friend. You also might consider naming an alternate agent should the primary agent be unavailable or unable to carry out the responsibility.
Your agent will be given a power of attorney to convey your wishes for accepting or withholding treatment. Your agent will obviously need a copy of your advance directive, as will your family members and trusted friends and associates, and certainly your primary physician and hospital of choice.
It’s important to note that the advance directive applies only to decisions in the hospital. Emergency medical personnel, such as ambulance attendants, are not bound by it. If you wish to restrict treatment by emergency personnel, then you can create what is called an out-of-hospital do-not-resuscitate (DNR) order. This will allow you to die a natural death on the way to the hospital, but it does not restrict the use of palliatives to ease your pain and suffering.