What Are Advance Directives?

Advance directives: Why do they matter?

Advance directives matter because they make sure your health care wishes are known and followed if you’re unable to communicate or make decisions for yourself. HealthSpring is your partner for your health care journey. That includes planning your care before you need it. Learn why advance directives are an important part of your advance care planning.

What are advance directives?

Advance directives are written instructions to your loved ones and caregivers stating the type of medical treatment and health care you would like to get if you are not able to communicate with your health care providers.

Living wills and durable power of attorney for health care are two types of advance directives.

What is a living will?

A living will is a legal document that states your preferences for medical treatment if you become terminally ill or permanently unconscious and unable to make decisions for yourself.

Terminally ill generally means that you have a medical condition that cannot be cured or reversed and will result in death within a somewhat short amount of time. Permanently unconscious generally means that you are in a permanent coma or a persistent vegetative state. These are irreversible conditions in which you are not aware of yourself or others and show no response to things around you.

What is a durable power of attorney for health care?

A durable power of attorney for health care is a written legal document in which you name another person to make health care decisions for you if you become unconscious. This person is called an agent or a health proxy. It is a way to give someone else the legal power to make medical choices for you when you no longer can.

In the durable power of attorney for health care, you can give general or specific instructions to your agent about:

• Your goals, values and preferences
• How you want your agent to make health care decisions for you
• Where you would like to get medical care
• Types of medical treatment you want or don’t want
• Instructions about artificial nutrition and hydration
• Mental health treatments
• Organ donations
• Funeral arrangements
• Who you would like to have as a guardian or conservator, or a person or organization that will manage your personal and financial matters if one is to be chosen for you by the court

Can I name more than one agent to make health care decisions for me?

Yes, you can name more than one agent to make health care decisions for you, but you should clearly state how decisions will be made. If you have more than one, you should specify if only one can make the final decision for you or if they must work together. There are advantages and disadvantages to having more than one agent.

For example, it may be hard for all of them to agree on each decision. If any one of them can make decisions for you, that may make it easier to get things done. But it may also cause serious disagreements if they are not given your instructions in advance. You can also name only one as your agent and name another as a substitute agent in case the first-named agent is not able to act for you.

How do I make my health care instructions?

There are forms available that you can use to write out your instructions. Some states have specimen forms, or standard templates, available at no cost to you. Or you can get a sample form from your local library or online. Most attorneys provide these forms as well and may be a part of your estate planning.

The following are legal requirements that make your health care instructions legally binding, meaning they must be carried out by law:

• You must be at least 18 years old at the time you sign the document
• The document must be in writing
• It must state your name
• It must be signed by you or someone authorized to sign for you
• Two people must witness you sign the document
• The document must be signed in front of a notary public

• If you want to have more than one agent, specify who is the primary, or first agent, secondary and so on and explain if they will make decisions together or who will make the final decision and include:

  • The name of each agent you specify
  • The address of each agent you specify
  • And your relationship to each agent you specify

• If you want to have more than one guardian or conservator, specify who is the primary, or first guardian/conservator, secondary and so on and explain if they will make decisions together or who will make the final decision and include:

  • The name of each guardian/conservator you specify
  • The address of each guardian/conservator you specify
  • And your relationship to each guardian/conservator you specify

Where should I keep my advance directives documents?

You should keep your advanced directives documents in a safe place that is free of potential harm from water or fire. It is also a good idea to give copies of your documents to the people who are most likely to need this information when the time comes, like your family and attorney. You should also give a copy to your primary care physician so that it can be placed in your medical file.

Will these documents be valid in other states?

Yes, advanced directives documents are valid in all 50 states if they are valid in the state in which they are written. But if you move to a different state, it’s a good idea to review these documents to make sure they obey that state’s rules.

Will doctors and hospitals honor my wishes about my health care?

The laws of most states require health care providers to honor your wishes about your medical care and treatment. Also, in most states, your health care agent has the right to find health care providers who will honor your wishes.

Disagreements can happen when there is no communication between health care providers and family members. That is why stating your wishes in the form of health care instructions and communicating them to your family members, attorney and your PCP is important.

How long will my advance directives last?

There is no time limit for advanced directives documents. In general, they will last until you change or end them. You may change them any time by signing new documents. In this case, it is a good idea to destroy your old documents. This makes sure the old documents are not confused with the new ones. You can end your advance directives by:

• Signing a written statement that explains you are ending the advance directives
• Destroying the documents and all copies
• Telling at least two people that you are ending them

Should a lawyer write my advance directives?

No, a lawyer does not have to write your advance directives. If you have any questions about any of these documents, you should talk to an expert on advance directives, like an estate planning lawyer. They are knowledgeable because they often write advance directives for their clients.

Final thoughts from Dr. T

Writing your advance directives can be uncomfortable for many reasons. Thinking of a situation where you may not be able to make health care decisions for yourself can be scary. Many professionals recommend discussing your options with loved ones and professional advisors. Your advance directives make sure you have a voice in your future care and can help give your caregivers and loved ones some peace of mind.

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