What Is an Advance Directive?

advance health care directive form

It is difficult and can be uncomfortable to talk to your loved one to plan for the end of their life. This isn’t a topic anyone wants to contemplate. However, discussing your loved one’s wishes now, before a medical crisis, is crucial. Getting all necessary documents in order ensures your loved one receives the desired medical care if they cannot communicate their wishes later.

An advance directive refers to any legal document regarding your health care preferences. The DNR or DNI order only goes into effect when a patient is incapacitated and unable to speak for themself—some examples are if they had a stroke, were in a coma, had dementia, or were under anesthesia. Having such documentation can bring relief to family members. Having your loved one’s wishes in writing keeps you from wondering if you “did the right thing” regarding their health care. It can also bring some peace to your loved one to know that their wishes will be respected.

Living Will

The most common type of advance directive is a living will. This is a legal document stating your loved one’s future healthcare wishes if they become unable to express them. Before a living will direct medical decisions, two physicians must confirm the patient’s inability to make decisions and their medical condition, as defined by state law.

A living will outlines end-of-life wishes, including organ donation preferences if applicable. It applies when your loved one is terminally ill, permanently unconscious, or unable to communicate. It details preferences for life-prolonging treatments like feeding tubes or life support in those situations.

A living will also indicates if your loved one wants a Do Not Resuscitate Order (DNR). A physician issues a DNR order when determining that your loved one has an end-stage medical condition or is permanently unconscious, indicating that CPR or other life support measures should not be attempted if their heart stops or they stop breathing. A DNR may also be referred to as DNAR (do not attempt resuscitation) or AND (allow natural death). Additionally, a physician issues a DNI (do not intubate) order to instruct medical personnel not to put your loved one on a ventilator.

A living will is not the same as refusing all medical care. Even if your loved one is incapacitated, they could still receive palliative care such as pain medication or antibiotics. The goal of treatment changes to comfort instead of attempts to cure.

MOLST and POLST

This can be another part of your loved one’s advance directive. MOLST is the Medical Orders for Life-Sustaining Treatment. This is called POLST or Physicians Orders for Life-Sustaining Treatment in some states. This is a set of medical orders based on your loved one’s current health status and prognosis.

These orders specify the life-sustaining treatment they want now. Unlike a living will, which addresses future treatment preferences, MOLST is completed and signed by the patient and takes immediate effect once signed by a physician, requiring healthcare professionals in all settings to honor its directives.

MOLST is not appropriate if your loved one is healthy or has a chronic condition with a long life expectancy. Having a living will is more relevant in this case. MOLST or POLST should be considered in cases of terminal diagnoses.

Healthcare Power of Attorney

A healthcare power of attorney (HCPA) is a legal document. It allows your loved one to designate someone they trust to make medical decisions if they cannot communicate. Those named in the HCPA are healthcare proxies. They can speak with your loved one’s doctors about treatment decisions. The HCPA takes effect immediately upon their incapacitation.

Writing an HCPA requires filling out a form and having it notarized. The healthcare proxy can be changed or revoked at any time by completing a new HCPA form.

Financial Power of Attorney

A financial power of attorney, also called a general power of attorney (POA), functions similarly to an HCPA. It allows your loved one to designate someone they trust to manage their finances and property. Typically, a POA is used if they are ill or unable to handle important paperwork physically. The person granted financial power of attorney can differ from the one with healthcare power of attorney.

A financial power of attorney automatically ends when the person who issued it dies. This means that the person granted POA’s ability to make financial decisions ends as well. The executor or personal representative named in the person’s will makes the financial decisions after the person’s passing.

Last Will and Testament

A last will and testament is a legal document. It specifies your loved one’s final wishes regarding their assets and dependents. It specifies their wishes for handling belongings and responsibilities, including custody of dependents, property, and management of accounts and financial interests. A will designates someone to be the executor of the estate. That person is responsible for administering the estate. The probate court typically supervises the executor to ensure the will’s wishes are executed as specified.

For more detailed information on advanced care planning and specific resources to help you with each step, visit the National Institute on Aging’s “Getting Your Affairs in Order”.

References

1 American Cancer Society, Types of Advance Directives. https://www.cancer.org/treatment/treatments-and-side-effects/planning-managing/advance-directives/types-of-advance-health-care-directives.html