ADVANCE DIRECTIVES – QUESTIONS AND ANSWERS

Q.  What are Advance Directives:

A. Advance directives include documents such as a living will and durable power of attorney for health care.  DNRs (Do Not Resuscitate Orders) are sometimes included under the heading of Advance Directives as well.

Q.  Why have Advance Directives?

A.  It is your right to accept or refuse medical care and if your aren’t able to communicate your wishes after you become injured or ill, your Advance Directives will represent your wishes for your care.  They protect your right to make medical choices.  It is now common for hospitals to present you with Advance Directives to complete upon admission to a hospital so that medical staff will know your wishes.

Q.  How will Advance Directives impact my family?

A.  Should you become seriously injured or ill, your family will be under tremendous stress.  Advance Directives will remind them of your wishes for care and take the burden of potentially difficult decisions off their shoulders.

Q.  What should I consider before making Advance Directives?

A.  Your religious beliefs, feelings about quality versus quantity of life, ability to make you own decisions, medical intervention and relieving your family of difficult decisions should all be factors when you consider making an Advance Directive.

Q.  Should I speak to anyone before signing an Advance Directive?

A.  It is good to speak with family and friends, your pastor or priest, your physician and your attorney prior to signing Advance Directives.

Q.  What exactly is a Living Will?

A.  Living wills are written documents that explain your wishes in the event that you are diagnosed with a terminal condition.  This document must be drafted and signed while you are still able to communicate your wishes.

Q.  What is a Durable Power of Attorney for Health Care?

A.  This is a written document and is not the same as a Power of Attorney or General Power of Attorney which are used to convey legal and financial decision making to another individual.  This document specifically addresses health care decisions.  It is sometimes called a Medical Power of Attorney.

Q.  When do these documents become effective?

A.  If two physicians determine that you are in a coma (or other unconscious condition), that you have sustained permanent brain damage or are terminally ill, the living will and durable power of attorney for health care are used to make you wishes known.

Q.  Where should these documents be kept?

A.  You should give a copy of your advance directives to your physician to be kept in your permanent medical record.  Your spouse or closest family members should have a copy.  It is also a good idea to keep a card in your wallet that tells what advance directives you have and where they are located.

Q.  Can I change advance directives once I have made them?

A.  Yes, you should review your advance directives regularly and make any changes as necessary.  Be certain to inform your physician and family or proxy of any changes.

The following is a brief definition and example of the three major types of Advance Directives:

Living Will – This document provides specific instructions regarding medical treatments should two physicians determine that you are no longer able to voice your wishes because you are in a coma, have irreversible brain damage or are terminally ill.  You may specify whether or not you want mechanical breathing (respirator), to be fed through a tube, intravenous feeding, surgery, heart/lung resuscitation (CPR) or any other procedures.  This document must be completed by an adult who is of sound mind in order for it to be a legal document.  For example, Beth is a 62 year old with terminal cancer.  She has chosen to complete a living will and does not want any of the above medical options to be used as she nears the end of her life.  She desires her caregivers to provide comfort measures only.  Comfort measures include pain relief, food and water as tolerated and non-invasive care.

Durable Power of Attorney for Health Care – This is also known as a Medical Power of Attorney.  In this document you name a specific individual and usually an alternate to make medical decisions for you.  These decisions include choosing physicians, authorizing medical care or treatment and placement in a rehabilitation or health care facility as needed.  For example, Fred is 50 years old but is concerned because both of his parents died of Alzheimer’s disease.  He appoints his wife, Ann, as his POA and she will make health care decisions for him when he is no longer able to do so. 

Do Not Resuscitate (DNR) – This states that you are refusing measures to revive your heart if it stops beating.  This would go into effect any time your heart stops beating and does not require a determination by two physicians as a Living Will does.  For example, Ben is a healthy 90 year old who could have a heart attack.  He does not have any terminal illnesses or other conditions which would trigger a Living Will.  He has decided that because of his convictions, when he dies he does not want any medical intervention but rather wants to let his life take its natural course.  He has signed a DNR and does not want to be resuscitated in the event of a heart attack.