What Is an Advance Directive?
Planning for future medical care means thinking about who should make decisions for you and what kind of care you'd want if you were ever unable to speak for yourself. An advance directive helps you put those wishes in writing before a medical emergency or serious illness occurs.
An advance directive is a legal document, or set of documents, used to communicate your healthcare preferences and, in many cases, identify someone who can make medical decisions for you if you can't make them yourself. The exact documents, terminology, and legal requirements vary by state.
You don't need to be elderly or seriously ill to make an advance directive. An unexpected accident, sudden illness, or medical complication can leave someone unable to communicate, regardless of age. Planning ahead gives you an opportunity to make your wishes known while you're able to consider your options.
What Does an Advance Directive Include?
The term advance directive can refer to different documents depending on where you live. It may include written instructions about medical treatment, the appointment of a healthcare decision-maker, or both.
Two common components are:
Living will: Records your preferences for certain medical treatments if you become unable to communicate your decisions and the conditions specified in the document are met. This may include preferences about life-sustaining treatment and end-of-life care.
Healthcare Power of Attorney or healthcare agent designation: Names someone you trust to make healthcare decisions on your behalf if you're unable to make them yourself, subject to the document's terms and applicable law.
Some states combine these functions into a single document, while others use separate forms. You may also encounter terms such as healthcare proxy, medical Power of Attorney, or healthcare representative. Their precise meanings depend on state law.
The important thing is to understand what your state's documents actually do rather than assume that a particular title means the same thing everywhere.
Why Is an Advance Directive Important?
If you're unable to communicate your wishes, the people involved in your care may need to make decisions without knowing what you would have wanted. Even when family members agree that they want what's best for you, they may have different ideas about what that means.
An advance directive provides guidance based on your preferences. It can help your healthcare team understand your wishes and give the person you've appointed a clearer sense of how you'd want decisions handled.
It also gives you an opportunity to think through your choices before you're under pressure. You can consider what matters most to you, which treatments you're comfortable receiving in certain circumstances, and whom you'd trust to make decisions if you couldn't.
Creating an advance directive doesn't mean you're expecting something bad to happen. It's a practical way to prepare for the possibility that you might someday need someone to speak or decide on your behalf.
How Do You Choose a Healthcare Decision-Maker?
If your advance care planning documents allow you to appoint someone to make healthcare decisions, take some time to choose the right person.
This should be someone you trust to take your wishes seriously, communicate with medical professionals, and handle difficult situations. It doesn't have to be your oldest child, your spouse, or your closest relative. What matters is that the person understands your preferences and is willing to take on the responsibility.
Talk with them before naming them. Explain what's important to you, discuss the kinds of medical situations you've thought about, and make sure they're comfortable with the role. You don't need to predict every possible medical circumstance, but an honest conversation can help them understand how you'd approach difficult choices.
It's also worth identifying an alternate if your state's form allows it. Your first choice may be unavailable or unable to serve when the time comes.
Remember that the person you appoint doesn't necessarily have unlimited authority over every medical decision. Their authority depends on the document, applicable law, and whether the conditions for acting have been met.
How Do You Create an Advance Directive?
The process depends on your state, but you can start with a few practical steps.
Learn your state's requirements. Find out which documents are recognized where you live and whether an advance directive includes a living will, a healthcare decision-maker designation, or both.
Think about your medical preferences. Consider what you'd want in serious circumstances, including your views about life-sustaining treatment and comfort care.
Choose a healthcare decision-maker. If your plan includes appointing someone, discuss the responsibility with them before naming them.
Complete the appropriate forms. Use forms from a reliable government source or get help from an estate-planning attorney or other qualified professional. Follow your state's signing, witness, and notarization requirements.
Share copies with the right people. Give your healthcare decision-maker a copy, discuss your wishes with your healthcare provider, and ask whether the documents can be added to your medical record.
Review your documents periodically. Your preferences, relationships, or health circumstances may change. Review the documents after major life events and follow your state's process if you need to update or revoke them.
Don't put the completed documents somewhere so secure that nobody can find them when needed. Let the people who may need to act know where the documents are kept.
Is an Advance Directive the Same as a DNR Order?
No. Although these terms are sometimes discussed together, they serve different purposes.
An advance directive communicates your healthcare preferences and may identify someone to make decisions for you. A do-not-resuscitate (DNR) order is a medical order concerning whether CPR should be performed in the circumstances it covers.
A living will may include preferences about resuscitation, but it isn't automatically the same as a DNR order. If you have specific wishes about CPR, ask your healthcare provider how those wishes should be documented and what medical orders may be appropriate for your circumstances.
It's also important to remember that an advance directive doesn't replace every other planning document. A financial Power of Attorney, for example, addresses authority over specified financial or legal matters, not automatically healthcare decisions. A will addresses certain matters involving your estate after death. Each document serves a different purpose.
Final Thoughts
An advance directive gives you a way to communicate your healthcare wishes and plan for who may make decisions if you're unable to make them yourself. It can help your loved ones and healthcare team understand your preferences during an already difficult situation.
You don't need to have every answer before you begin. Start by learning which documents your state recognizes, thinking about what's important to you, and talking with the people you trust.
The goal is to make your wishes known, ensure the appropriate documents are in place, and give the people who may need to act on your behalf useful guidance.
Up Next: An advance directive helps you plan for medical decisions during your lifetime, but it doesn't explain what should happen to your money, property, and belongings after you die. A last will and testament addresses those questions. In the next article, we'll explain what a will does, how to choose an executor, and why having one can help make your wishes clear to the people you leave behind.
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