All adults can benefit from thinking about what their healthcare choices might be if they were unable to speak for themselves. These decisions can be written down in an advance directive so that others know what they are.
Advance directives may include one or more of the following:
- Living will: Used for end-of-life or other healthcare decisions. For example, if you want to ensure that you do not receive any treatment that prolongs the dying process or you want to express your desires regarding tissue and organ donation. A living will may also inform your doctor about the kinds of life-sustaining treatments you want.
- Medical power of attorney: Used for you to appoint another person to be your "healthcare agent." This person will have legal authority to make medical decisions on your behalf should you be unable do so yourself.
- Do not resuscitate order: Used to request that your healthcare provider does not perform cardiopulmonary resuscitation (CPR) if your heart stops.
Advance directives take many forms. Laws governing advance directives vary from state to state.
Advance Directives Benefit Adults of All Ages
"This is something for adults of all ages, not just older adults, to think about," says Suzanne Leib, lead geriatric care coordinator at John Muir Health.
Still, according to the U.S. Agency for Healthcare Research and Quality, fewer than 50 percent of the severely or terminally ill patients have an advance directive in their medical record.
"It is better to express your wishes before you get sick. You can use an advance directive to say who you want to speak for you and what kind of treatments you want. This is the opportunity to be an advocate for the care that you want to receive," Leib says.
Who Makes Advance Directives
Anyone 18 years or older and capable of making their own medical decisions can have an advance directive. You can choose an adult relative, spouse, friend, or other trusted person to speak for you as your healthcare agent for medical decisions.
Usually, a healthcare agent will make decisions only after you lose the ability to make them for yourself. But if you wish, the agent can begin making decisions immediately.
"After you choose your healthcare agent, talk to that person about what you want," notes Leib. "Sometimes treatment decisions are hard to make, and it truly helps if your agent knows what you want. Don't assume that what is on paper will be understood."
It is also important to share your decisions with your family and medical team and make sure the person you have selected as your healthcare agent is comfortable in that role and willing to be your voice.
When creating your advance directive and designating a healthcare agent, you generally are giving the agent the following responsibilities:
- Consent or refuse consent to any care, treatment, service, or procedure to maintain, diagnose, or otherwise affect a physical or mental condition.
- Select or discharge healthcare providers and institutions.
- Approve or disapprove diagnostic tests, surgical procedures, and programs of medication.
- Direct the provision, withholding, or withdrawal of artificial nutrition and hydration and all other forms of health care, including CPR.
- Donate organs or tissues, authorize an autopsy, and direct disposition of remains.
"It is also important to remember that even though you sign the advance directive now, it does not take effect until such time as you are unable to speak for yourself or make decisions for yourself," says Lawren Hicks, MD, medical director for senior services at John Muir Health.
How to Change Your Advance Directive
You can change or cancel your advance directive at any time as long as you can communicate your wishes. To change the person you designate to make your healthcare decisions, you must sign a statement or tell the doctor in charge of your care.
The advance directive is valid forever, unless you revoke it or specify an expiration date. "More than anything the advance directive is a flexible document," adds Leib.
"Medical needs change as we age and it is important to make any changes and see if the advance directive still meets your needs. For some, revisiting the document every year may be more appropriate," Leib says.
Your doctor can provide more information about advance directives. You can also consult with an attorney for any legal questions relating to living trusts, power of attorney, etc. For a free copy of an advance directive that you can complete, download the file.