Putting Priorities on Paper: Your Advance Directive

An advance directive is the cornerstone of your advance care planning. It makes your end-of-life preferences clear if you are unable to make or communicate medical treatment decisions yourself. Typically an advance directive includes a living will (“what I want”) and a medical durable power of attorney (“who will speak for me”). It can also include other documents to spell out your wishes. In most states, a lawyer is not required to complete an advance directive, but legal advice may help ensure your advance directive is valid. Since laws in each area are a little different, an advance directive filled out in one state may not be honored in another state. The best way to ensure wishes are honored is to complete an advance directive for the state in which you live, as well as for any states in which you spend a lot of time or receive medical care.

Your living will specifies what kinds of treatment and care you would or would not want in order to sustain life. Your durable power of attorney authorizes someone you trust to act as your representative and make medical decisions for you if you cannot make them for yourself. These are healthcare documents and do not include financial, estate, or business concerns. Advance directives are only useful if they are completed before a health crisis, shared with your healthcare team, and available when you are unable to speak for yourself.

COMPLETING YOUR STATE-SPECIFIC ADVANCE DIRECTIVE

Many states have their own forms with specific guidelines that must be used. To find state-specific advance directive forms, visit CaringInfo at Caringinfo.org/planning/advance-directives.

COMMUNICATING YOUR ADVANCE DIRECTIVE

Your advance directive can be helpful to your healthcare provider and others close to you when choices are being made on your behalf. However, the documents alone do not guarantee enforcement. That’s why it’s important to appoint someone who understands and supports your values as your healthcare representative or agent. Take the time to communicate your wishes to that person as fully and clearly as possible and give them a copy for their files. It is also a good idea to bring an up-to-date advance directive to your healthcare provider to discuss your healthcare wishes and have the document scanned into your medical records.

ADDING OTHER DOCUMENTS

Throughout this guide you will find references to other resources that can be added to or accompany your advance directive. Documents and links can be found in the Advance Planning Toolkit included with this guide and online at CandC.org/tools. Some specific medical orders may need to be signed by a healthcare provider. The more information you can provide to prevent conflicting interpretations of your preferences, the greater the likelihood those preferences will be followed.

STORING AND REVIEWING YOUR ADVANCE DIRECTIVE

To be useful, your advance directive needs to be easily accessible and up to date. Review your advance directive anytime there is a significant life change (death, divorce) or new diagnosis, and, at minimum, every 5-10 years. Give a copy to your designated healthcare representative, keep another in an obvious place at home so your representative or loved ones can find it, and bring one to your primary healthcare provider to keep in your medical records. Review your documents regularly.

TIPS FOR SELECTING YOUR MEDICAL SURROGATE (PROXY) AND REMINDERS FOR YOUR ADVANCE DIRECTIVE:

• A surrogate is the person you name as your healthcare proxy. They have the power to advocate for your medical wishes and make healthcare decisions for you if you are unable to do so. This person is named in your advance directive, a legal document. (See more about selecting a representative on page 14.) A good surrogate is someone who:
  • Is willing to take the time to understand what is important to you.
  • Can be trusted to carry out your wishes, even if they differ from their own.
  • Knows how to advocate and will speak up in a crisis.
  • Will be able to make difficult decisions in stressful situations.
  • Will be comfortable navigating family dynamics if needed.
• Discuss your wishes and provide a copy of your advance directive to your surrogate decision-maker, loved ones, and medical team.
• If you update your advance directive (you can, at any time), discard the document you no longer want and replace it with a revised version. Share the revised version and ask others to discard the one you no longer want.
• Review your advance directive annually (or at minimum, every 5-10 years) and update when any one of the “5 Ds” has occurred: Death of a loved one, Divorce, a new Diagnosis, Decline in health or you reach a new Decade.
• Keep your advance directive in a place where it will be easily found by your surrogate decision-maker and/or loved ones.
• Make sure your advance directive will be honored in all states in which you receive care or frequently visit.
• Consider keeping a copy with you when you travel or know you will be away from home for a long period of time
• Talk with your medical team about completing a POLST – Physician Orders for Life Sustaining Treatment (also known as a MOLST – Medical Orders for Life-Sustaining Treatment) form.

An advance directive is a key part of any end-of-life plan. It lets others know “what I want” and “who will speak for me” if you become unable to make or communicate medical treatment decisions for yourself. Complete it early, communicate it fully, and make it easy to find.

NEXT: Decisions About Life-Sustaining Measures