My 86-year-old grandma still washes her own windows (with a pressure washer no less), drives to the nursing home every Tuesday to visit the residents, whips up big ‘ol Southern meals for her neighbors and spends a lot of time outside tending to her flower gardens. Needless to say, she gets around pretty well.
As much as I don’t like to think about it, a time may come when she has to make decisions about medical care at the end of her life.
But what if she’s not able to make decisions for herself? And what if her family has no idea what her wishes are?
Fortunately, there is a way for my grandma to outline, ahead of time, what type of care she would (or would not) want if she is ever in a situation where she can’t make these decisions on her own. She can make her wishes known using advance directives.
What Are Advance Directives?
Advance directives are legal documents that consist of a living will and healthcare proxy (also called durable power of attorney for health). A living will outlines your wishes concerning end-of-life medical care based on your own values, beliefs, and preferences. A healthcare proxy is someone you assign to make decisions on your behalf if you’re not able.
Other types of advance directives include ‘Do Not Resuscitate’ orders, POLSTs and MOLSTs.
We’ll discuss all of these in a little more detail later.
Why Everyone (Young or Old, Healthy or Sick) Should Have Advance Directives
I’ll never forget a patient I took care of when I was working in the intensive care unit of a cancer hospital in New York City. Mr. B was a 29-year-old man who was in a coma and dying from end-stage cancer. He and his lovely wife had their first child a few months before he was diagnosed.
Unfortunately, Mr. B didn’t have advance directives. Before cancer struck, he was young, healthy and looking forward to a future with his growing family. The thought of planning for end-of-life medical care never crossed his mind.
Because Mr. B was now in a position where he couldn’t make decisions for himself, the onus was on his wife. She had to make incredibly difficult choices regarding his medical care in a time of overwhelming anguish. It was heartbreaking for everyone.
No matter your age or current health status, you should have advance directives in place. An incurable illness or tragic accident could leave you unable to make decisions for yourself.
By planning in advance, you may avoid unnecessary suffering at the end of your life. You’ll also relieve your loved ones of the burden of having to make tough choices for you if you are too sick.
Now let’s take a closer look at what advance directives entail.
A living will is a legal, written document that tells your healthcare team, and loved ones, what type of medical care you would, or would not, want if you are unable to make decisions for yourself.
Some people choose to have very general instructions in their living will and some opt to be very specific. It’s up to you to decide what to include in yours.
Some examples of things to address are your wishes regarding:
- Cardiopulmonary resuscitation (CPR)
- Mechanical ventilation
- Comfort care
- Organ donation
You can get free advance directive forms for your state from AARP.
Your healthcare proxy (also called durable power of attorney for health) is the person you designate to make medical decisions for you if you aren’t able.
Even if you have a living will, it’s really important to assign someone to act on your behalf.
Different states have different requirements for designating a healthcare proxy.
In general, you should choose someone who:
- Is comfortable and capable of discussing end-of-life issues with you.
- You trust to advocate for you if there are disagreements about your care with other family members or your healthcare team.
- You can rely on to carry out the directives in your living will.
Your proxy can be a spouse, family member or friend. You can also assign alternates.
Do-Not-Resuscitate (DNR) Order
If you have an illness or condition that is not going to improve, you can choose if you want a do-not-resuscitate (DNR) order. This is a medical order written by a doctor that lets the healthcare team know not to perform cardiopulmonary resuscitation (CPR) if your heart or breathing stops.
Tell your family and healthcare team your preference.
A living will is not necessary for a doctor to write a DNR order.
Just be aware, a DNR order is only valid if you’re in the hospital. If you don’t want CPR outside of the hospital, you have to ask your doctor to write an ‘out-of-hospital’ DNR order.
POLST & MOLST
Like a DNR, a Physician Orders for Life-Sustaining Treatment (POLST) is a medical order that outlines your specific wishes for end-of-life care. In some states, these orders are called Medical Orders for Life-Sustaining Treatment (MOLST).
So what’s the difference in a POLST and your advance directives? The POLST is usually ordered by a physician when you are already seriously ill or at the end of your life. It complements, not replaces, your advance directives.
You can go to the National POLST Paradigm to learn more about your state’s POLST (or MOLST) orders.
What Else Should I Know?
Here are a few other things you should know about advance directives:
- Review your advance directives periodically or if there are changes in your condition. Make sure they are still in line with your wishes. Let your family and healthcare team know if you make updates.
- Your advance directives never expire.
- Advance directives are legal documents. They become valid as soon as you sign them in front of a required witness.
- You can hire an attorney to help with your advance directives, but it’s not necessary if you feel comfortable doing them on your own.
- Advance directives are not honored if you are attended to by emergency medical technicians or paramedics. If called, they must stabilize you in an emergency.
- Your advance directives may not be valid in states other than your own. Some states do honor interstate directives, while others do not.
Get your free Advance Directives Quick Guide by clicking here.
- A living will tells your loved ones and healthcare team what your wishes are for medical care if you aren’t able to make choices for yourself.
- A healthcare proxy is someone you designate to make decisions about your medical care if you’re unable.
- Everyone should have advance directives.
- The legal implications of advance directives vary by state.
- A DNR order tells the healthcare team not to perform CPR if your heart or breathing stops.
- POLSTs/MOLSTs are similar to advance directives but are usually ordered when you are already very ill or at the end of your life.
- Advance directives cannot be honored by emergency responders.
- You can get your free Advance Directives Quick Guide by clicking here.
I hope this has helped you understand what advance directives are and why it’s so important to have them!
Have a question for me? Or just want to talk about your experiences with the healthcare system? Email me at firstname.lastname@example.org