The end of life sometimes begins with an advance directive. Learning about advance directives now may make things easier for your loved ones later, when they’re in a hospital room trying to decide what your wishes might have been.
“Advance directives are important for many reasons,” says Evan H. Farr, a certified elder law attorney at Farr Law Firm P.C. in Virginia, Maryland and Washington, D.C. “Incapacity occurs more frequently than many people assume, and the process by which a person becomes incapacitated can be gradual, as with dementia or other neurodegenerative disease diseases, or instantaneous, such as a stroke.”
So if you’re unclear on what an advance directive is — and it’s often used as a catch-all term for a lot of end-of-life decisions — here’s a quick primer with answers to questions like, “What is advance directive for health care?”
[READ: How to Prepare for End of Life: Medical Care and Planning]
What Is the Meaning of an Advance Directive?
An advance directive, also often referred to as an advance health care directive, is a legal document that gives guidance to doctors treating an infirmed patient who isn’t able to communicate. Ideally, every adult will have an advance directive, though surveys have suggested that not many people do.
An advance directive can cover a lot of ground when it comes to end-of-life health care and your future medical wishes.
An advance health care directive can include many parts:
— A living will
— Do-not-resuscitate orders, or a DNR
— A health care power of attorney
[READ: How to Manage Sibling Conflict Over Care of Elderly Parents]
An advance directive typically covers the living will, the DNR, the medical power of attorney and generally any other decisions with end-of-life care. For instance, Farr suggests that an advance directive also include an after-death directive, which “details how you wish to have your remains buried, cremated, donated for organ transplant purposes, etcetera.”
However, this information doesn’t necessarily have to be in an advance directive. “Some attorneys provide this as a separate, stand-alone document,” he says.
Nevertheless, the more details in an advance directive, the better.
“When a person lacks clearly articulated written authority and direction regarding their future health care needs, their loved ones will often be forced to guess, argue, and/or seek court intervention through guardianship and conservatorship, also known as lifetime probate,” Farr says.
Advance directives ideally will be coordinated with your estate plan, because sometimes the reality of what you may want for your health care and what you can afford won’t always match up.
Another way to put it: Do you have plans for what should be done if you’re barely alert and lying in a nursing home bed for several years? If you don’t, you may want to look into purchasing long-term care insurance.
[READ: 9 Steps to Plan Ahead for Long-Term Care]
What Is a Living Will? Defining Your Treatment Wishes
A living will is a legal document that details what type of medical treatment you want and don’t want if something happens to you, and you’re unable to discuss your medical care. For instance, if you’re unconscious and not able to breathe on your own.
Many people treat a living will “as covering all aspects of a person’s potential incapacity when it actually only applies to terminal and end-stage conditions,” notes Farr.
If you don’t have a living will, doctors will do everything to save you, and many people will enthusiastically endorse that idea. But if you’re nearing the end of your life, and you worry that saving you could simply mean you end up suffering up until your last breath, you may feel that you don’t want any heroic measures taken to keep you alive. On the other hand, you may feel like you’d rather be alive no matter what and want your physicians to do all they can to keep you going.
A living will addresses those topics, and you can go deep into the weeds on possible medical care, discussing in the document whether you want CPR or electric shocks, also called defibrillation. You may or may not want doctors to put you on a ventilator, a machine that uses a tube in the throat to push air into the lungs to help you breathe.
A living will might discuss your pacemaker or implantable cardioverter-defibrillator (ICD), if you have either of those. It also might detail whether you want a feeding tube or fluids going into your body through an IV.
Of course, if you’re not a medical professional, you may really have no idea what type of medical care you want. That’s why it can be helpful to discuss these issues with legal or medical professionals who are steeped in this information and can guide you.
These are not easy decisions, according to Cryst’l Scheer, an end-of-life doula and founder of Summit Care, an end-of-life wishes consultancy that focuses on services such as advance care planning and beside care plans.
“Before becoming an end-of-life doula, I worked in hospice for six years, where I’ve seen firsthand what happens when people haven’t documented their wishes — families struggling to make medical decisions, arguments over what their loved one would have wanted and unnecessary suffering because no one knows the next step,” Scheer says.
A living will, ideally, will give family members and doctors guidance on what the next step is.
It can really reduce a lot of stress for your family — and give you peace of mine, Scheer says. A living will, and an advance directive in general, she says, “offer people the chance to discuss their values, beliefs and instructions for care when they become incapacitated and are no longer able to speak for themselves.”
[READ What Is Palliative Care, and Can You Get It at Home?]
Designating a Health Care Power of Attorney (POA)
While a living will details your instructions on what to do if you aren’t able to speak for yourself, you can’t know the future. So if you give a family member or trusted friend medical power of attorney, they can make any day-to-day decisions you can’t.
There are limits to what decisions they can make. If what they want is different than what you said you want in your living will, your living will typically takes precedence.
Also, physicians may be able to override the family member if it’s clear that they want something that is unreasonable. But those are worst-case scenarios, and that’s what a medical power of attorney generally helps avoid. If you have given a family member or friend who you truly trust the right to make medical decisions on your behalf, and you’ve discussed your wishes with them, they’re likely going to do everything they can to ensure you get the type of health care that you want.
It also means that one person you have designated will be making your medical decisions, rather than a committee of your family members, who might all have different ideas on what should be done.
If you’re close to death, and family members are worried that a decision could prematurely end your life or cause you to suffer, this is going to be a frightening time, Scheer points out. But “having difficult conversations about future medical decisions prepares loved ones to support and advocate for a patient during times of stress and fear,” she says.
If possible, Scheer says, “every adult should have an advance directive well in advance of a medical crisis.”
[READ: How to Pay for Nursing Homes With Hospice Care: Payment Options]
Frequently Asked Questions About Advance Directives
Is an Advance Directive the Same as a DNR?
Not really. A DNR refers to a do-not-resuscitate order. A DNR is a legal document that states that if you were to stop breathing, you don’t want doctors to do CPR (cardiopulmonary resuscitation).
A DNR can be part of an advance directive, but an advance directive is also a legal document that provides instructions for end-of-life care if the patient can’t communicate on their own. An advance directive may include a DNR in the document — but it also may include additional end-of-life medical information.
Does an Advance Directive Override a POA?
Typically, yes, an advance directive will override a POA, or power of attorney. In this case, it would be associated with a medical power of attorney, also sometimes referred to as a health care power of attorney or a health care proxy. (You can also have separate power of attorneys, such as a financial power of attorney, where a family member makes financial decisions for a loved one but not the medical decisions.)
A health care POA is a legal document that gives a family member the power to make important medical decisions on a patient’s behalf if they are unable to communicate their wishes. For instance, if the patient is in a coma or has dementia.
The reason that an advance health care directive will usually override a power of attorney is because it was formulated and signed by the patient when they were able to make their own decisions. So generally, hospitals and courts will side with the advance directive instead of the person with a health care power of attorney.
What Are the 3 Types of Advance Directives?
Really, there’s only one type of advance directive; it’s a misconception that there are different kinds.
“Most people erroneously associate advance directive with a single document, often a living will. The fact that many confuse a single document for a series of inter-related decisions is a significant problem,” Farr says.
An advance directive is one legal document. However, there are three main types of decisions that you’ll need to make that are in an advance directive.
1. What type of medical care do you want if you are terminally ill or in coma? This is where a living will can solve a lot of potential problems. It’s a document that explains what type of medical treatment you want and don’t want if there appears to be no chance of recovery, and you’re unable to weigh in on whether you want extreme measures to be put in place to keep you alive.
2. If you can’t make medical decisions, who will make them for you? This is decided in a durable power of attorney for healthcare, a document that allows somebody to make medical-related choices for a patient unable to make them.
3. If you stop breathing, and it appears you’re not ever going to be able to have a meaningful chance of recovery, do you want doctors to try to get you breathing again? Since you obviously can’t answer that question while you’re unconscious, here’s where a do not resuscitate order, known as a DNR, comes in. A DNR is a legal document explaining your wishes for physicians not to intervene with, for instance, CPR if your heart stops.
What Is the Difference Between a DNR and an AMD?
A DNR, also known as a do-not-resuscitate order, are instructions to not to offer a patient CPR if a patient’s heart stops. An AMD stands for advance medical directive. It’s a broad legal document covering end-of-life wishes of a patient. An advance medical directive may include a DNR in its plans, but it may also include other legal documents as well, such as an explanation of who can make health care decisions for the patient if the patient is unable to.
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Advance Directives: Your Complete Guide to Living Wills & Health Care Power of Attorney originally appeared on usnews.com
