What is an Advance Directive?
I vividly remember the first time I seriously thought about creating an advance directive – also known as a living will. It was 1998 and the Terri Schiavo case was all over the news. Terri was just 26 years old – and seemingly healthy – when she went into cardiac arrest that left her severely brain damaged and in a vegetative state.
Eight years later her husband went to court to have her taken off life support. He testified that early in their marriage they discussed what they wanted to happen should an emergency occur and they weren’t able to speak for themselves. According to her husband, neither wanted to be kept alive through feeding tubes, nor did they want to be dependent on others if there was no hope for recovery.
But like so many things we put off, they never got around to creating an advance directive. Her parents fought the husband’s action, and because Terri didn’t have an advance directive, what ensued in the courts was ugly and took years to settle. It didn’t have to be that way. Had Terri made an advance directive, her wishes would have been known.
I don’t know about you, but that scenario scares the living daylights out of me. It could have been solved with an advance directive. But what is an advance directive? Let's take a look.
Creating an Advance Directive
An advance directive is a legal statement that outlines medical treatment you wish to receive if you are unable to communicate. For example, if you're in a coma, your power of attorney can reference your advance directive to provide instructions to doctors. Since it's a legal document, it must be followed.
I know precisely what I want to happen to me in that situation. I don’t want to be kept alive through artificial means if my physician has said that I am terminal and there’s no hope of living the kind of life I want.
I created an advance directive with a power of attorney for health care incorporated into it that spells out my wishes regarding resuscitation should I stop breathing, the usage of feeding tubes, as well as other procedures that might be contemplated to prolong my life.
By creating these documents, I’ve taken charge of my health care decisions instead of leaving them to someone else. It’s also the only way healthcare providers and my family will know exactly what I want to happen.
Selecting a Power of Attorney
In a power of attorney for health care, you name someone you trust as your personal representative to make the necessary health care decisions for you when you’re unable to and to make sure doctors and/or hospitals follow your advance directive wishes. There’s also room on most of the forms to name a second and/or third person should the first or second person be unavailable.
You need a power of attorney for health care in addition to the advance directive since not every situation can be predicted and may not be covered in your advance directive. The power of attorney will serve to fill in the gaps.
I know that sounds terribly frightening, giving someone else the power over your health care decisions. However, it only comes into play if a doctor certifies that you can no longer make educated decisions about your health care for yourself.
By having both a power of attorney for health care and an advance directive, you will prevent problems from arising if there’s a disagreement among family members on what to do about end-of-life decisions for you, such as happened in the Terri Schiavo case.
Always Communicate Your Wishes
If there is disagreement among family members regarding your care, doctors may not honor the advance directive. Therefore, most lawyers recommend that in addition to having the power of attorney for health care, that you also discuss your wishes ahead of time with both your doctor and the people who will most likely be your decision makers.
It’s a good idea to make several copies of both your power of attorney for health care and advance directive. They should be kept in clearly marked sealed envelopes, with one set at home for yourself, another with the person who you’re designating as your decision maker in your power of attorney, and another with your doctor. I’ve also told my kids where to find these documents in my home so they can access them if needed.
Creating an Advance Directive
Forms for both an advance directive and power of attorney for health care are available at no charge online. In the U.S., they’re state specific. You should also be able to get them from your local hospital.
The forms are easy to complete. Basically, all you have to do is fill in the blanks, have your signature witnessed, notarized, and you’re done.
Lawyers advise revisiting these documents every few years to make sure there aren’t changes you want to make to them. Also, should you move, it will be necessary for you to revise the documents since laws differ from state to state in the U.S.
It's a Personal Choice
Making medical decisions is intensely personal.
In many instances, one’s religious belief and/or innermost feelings regarding being kept alive through life support come into play. Those feelings or beliefs may be in conflict with the Hippocratic oath a physician has taken.
I remember when my grandmother had a heart attack and was in the hospital. She wasn’t conscious. I knew she didn’t want extraordinary means taken to keep her alive, but at that time, there was no such thing as an advance directive available and we couldn’t prove what she wanted.
I was in the room when she suffered her second heart attack in two days. The doctors and nurses came running in and did everything they could to get her heart beating again, only to have her suffer another heart attack the next day and have them go through the process all over again. I didn’t understand how they could allow her to suffer that way, but the doctor considered it his duty to keep her alive as long as possible through whatever means.
Only you should make life and death medical decisions. Having an advance directive and a power of attorney for health care will enable you to do just that.