Illnesses and accidents can strike at any age. For the sake of loved ones, it's important to think ahead to what kind of care you want if you become unable to speak for yourself. These frequently asked questions (FAQs) address common concerns.

• What is an advance directive?  
• What is a living will?
• What is a durable power of attorney (POA) for health care?
• When should I write an advance directive?
• How can I write an advance directive?
• Can I include specific wishes on the forms?
• What happens if I don't fill out any advance directive forms?
• Could HIPAA provisions prevent the patient advocate from receiving medical information about me?
• Where can I find the forms?
• Can I change my advance directive?
• Who should have a copy of the forms?
• Once my forms are completed, is there anything else I need to do?

  

What is an advance directive?

An advance directive refers to the written instructions for your future medical care if you become unable to make or communicate health-care decisions yourself. An advance directive typically includes a living will and a durable power of attorney (POA) for health care. However, laws about advance directives, and the forms used, vary across states. It’s important to understand that an advance directive is not the same thing as a will.

What is a living will?

A living will states in detail what care you would--and would not--want if you couldn’t express your wishes. It comes into effect when you, as determined by physicians, are terminally ill, faced with a life-threatening situation, or in a persistent vegetative state (commonly referred to as a coma).

What is a durable power of attorney (POA) for health care?

This legal document names the person you appoint to make health-care decisions for you. Also referred to as a patient advocate or a health-care surrogate, the person may not be a minor and must be willing to serve. You may choose a family member, friend, or anyone else you trust. If you want the advocate to refuse treatment and let you die, you must say so specifically in the document. This document comes into effect only when you’re not able to make health-care decisions for yourself.

When should I write an advance directive?

If you are an adult and don’t already have an advance directive, you should make it a priority to put one in place as soon as possible—even if you are young and healthy.

How can I write an advance directive?

Advance directives don’t have to be complicated legal documents. You can complete a short, usually simple form provided by your physician, health department, or state department on aging, or one you download from the Internet. Or you can use a computer software package for legal documents that’s compliant for your state. You also can talk to a lawyer, which could be particularly helpful if you live in more than one state during the course of a year, you have special or complex requests, or you don’t fully understand the standard forms.

Can I include specific wishes on the forms?

Yes. It’s best to be as specific as possible. For example, you may want to state that you don’t want your heart restarted. You may not want to go on a breathing machine, or ventilator. You may want your physician to try aggressive--and potentially uncomfortable--treatment for a while, but specify that it be stopped if your condition doesn’t improve. You also may have special requests based on religious beliefs. Write in any instructions that are not already included on the form. If you want to donate your organs and tissue after you die, you also should add completing a donor card to your to-do list.

What happens if I don’t fill out any advance directive forms?

Your doctor may have to provide medical treatment within the limits of the law, which may not be what you want. Your family members may be deeply divided over what they think you would want. And those you leave behind could be left with lingering doubts about whether they succeeded in fulfilling your unwritten wishes.

Could HIPAA provisions prevent the patient advocate from receiving medical information about me?

Maybe. To make sure privacy provisions in the Health Insurance Portability and Accountability Act (HIPAA) don’t keep the people named in your advance directives from receiving medical information about you, add a clause to your durable power of attorney for health care and living will forms stating that your agent has authority to receive information under HIPAA.

Where can I find the forms?

Forms are available from physicians, hospitals, attorneys, and several Web sites, such as the one provided by the National Hospice and Palliative Care Organization. Consumers Union recommends the American Bar Association’s free workbook Tool Kit for Health Care Advance Planning," as well as Five Wishes, a form from Aging With Dignity, a national nonprofit group in Tallahassee, Fla. ($5) The Five Wishes advance directive is different from a standard living will in that it includes your wishes about how comfortable you want to be, how you want people to treat you, and what you want your loved ones to know at the end of your life.

Can I change my advance directive?

Yes. You can change the forms at any time, as long as you’re considered of sound mind. That means you’re still able to think rationally and communicate your wishes in a clear manner. Make sure the changes you make are signed, dated, and notarized or witnessed, if required by your state laws.

Who should have a copy of the forms?

Give copies of the forms to your patient advocate or health-care surrogate, physicians, hospital, family members, clergy--anyone who has an interest in your medical treatment. Keep a copy with your will (keep neither document in a safe deposit box). And bring the forms with you any time you are admitted to a hospital. You may wish to submit a copy to the U.S. Living Will Registry, which will store it at no charge, and makes it available to health-care providers 24 hours a day.

Once my forms are completed, is there anything else I need to do?

According to the American Bar Association (ABA), studies show that standard advance directive forms do little to influence end-of-life decisions without personal communication about your wishes and values between you and your likely decision makers before a crisis occurs. Hearing the words from your own lips, rather than just reading them on a piece of paper, will do a lot to convince those closest to you that you really do want your wishes carried out.

 

 

 

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Published July 31, 2007

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