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Advance directives: Putting your health care preferences in writing

Putting your health care preferences in writing

Created date

January 7th, 2014
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Making decisions about your health care is something you’ve done throughout your adulthood, but what if you became ill and couldn’t communicate your wishes? According to the National Institute on Aging, more than 25% of older Americans face medical treatment questions near the end of life but are incapable of making those decisions. 

That’s one reason why advance care planning is important. Even if you are well and confident that you have many healthy years ahead, you could become incapacitated for a period of time because of an acute illness, trauma, or a major surgery.

Getting started

Having advance directives in place is the goal of advance care planning. “Advance directives have two main parts—a living will and a durable power of attorney for health care,” says Myla Carpenter, M.D., medical director at Charlestown, an Erickson Living community in Catonsville, Md. 

Advance directives forms can be found in a number of places, including your state’s department of health (and website), department on aging, a hospital, or your doctor’s office. There are also many faith-based organizations that have customized forms. These forms are free and cost nothing to complete (unless a notary fee is required).

But before you start filling them out, talk to your doctor. “The documents may seem fairly straightforward, but you need to completely understand them first,” Carpenter says. “And it is essential that your doctor knows that you have—or are planning to formulate—advance directives.”

According to a report from the Agency for Healthcare Research and Quality, up to 75% of physicians whose patients had an advance directive were not aware the documents existed.

Your living will

In a living will, you specify which kinds of medical interventions you would want and under which conditions. Your doctor is an important resource for this information. “I can educate you about the different options and make sure you understand treatments such as ventilators and feeding tubes, and what resuscitation actually means,” Carpenter says. “We can also discuss how your current medical conditions might affect your future health, and under which circumstances you would want comfort care.”

Depending on the state, a living will can be known as a health care declaration, directives to physicians, or medical directives. The form can be as simple or as detailed as you want, but because you cannot predict every possible scenario, having a durable power of attorney for health care is essential.

Your health care proxy

The durable power of attorney for health care has nothing to do with finances. It is a document that specifies the person who will be your health care agent or proxy if you become unable to make health care decisions for yourself.

“Although the document is written in advance, it goes into effect only when you become incapacitated,” says Dan Morhaim, M.D., Maryland state legislator, Johns Hopkins faculty member, and author of the book The Better End (Johns Hopkins University Press, 2011). 

The person you choose should be someone who knows about your preferences with regard to treatments, but also someone who is familiar with your general values, as unexpected situations might arise that are not addressed in your living will.

“Some people are hesitant to write a living will and would rather give their proxy complete authority and flexibility with decision-making in any medical scenario,” Carpenter says. “In any case, you decide what kinds of decisions your proxy can make for you.”

It is not necessary to hire a lawyer to write your advance directives. “Typically, two witnesses are needed when the directive is signed, and only a few states require notarization,” Morhaim says. 

Supplemental forms

In many states, people have the option of having a supplemental form in place called a MOLST, or Medical Orders for Life-Sustaining Treatment, or POLST, Physician Orders for Life-Sustaining Treatment.

“A MOLST/POLST is a document completed and signed by a physician after discussion with the patient,” Morhaim says. “It outlines specific medical treatment options such as transfusions, dialysis, and CPR, and whether these are desired and medically useful.” 

A MOLST is recognized and used in several health care settings, including hospitals, hospice, dialysis, home health, and continuing care. “Usually, these forms are completed for high-medical risk individuals, although anyone can have them,” Morhaim says. 

At the very least, advance directives should be reviewed and updated every year, but Morhaim says you can modify and update your forms at any time. If your health status changes significantly, or you are admitted to a facility such as a hospital or long-term care, you should also review all of your documents.

You’ll need more than one copy. You should keep one set, and your doctor and health care proxy or a trusted family member or friend should keep the others. And because each state differs with regard to advance directives laws, prepare forms for other states where you spend a significant amount of time.

If you choose not to have advance directives, officials from your state of residence will assign someone to make your health care decisions. But that person may not know you or be familiar with your wishes and values. “Remember that you have a choice,” Carpenter says. “By having advance directives, you are exercising your wishes about your health care.”

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