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Doesn't
an advance directive just mean, "Don't treat"? |
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Advance directives are most often used so that people can avoid being kept alive artificially against their wishes. But it doesn’t have to be, and shouldn’t be, a single, blanket statement. Your advance directive should say what you do want as well as what you don’t want, and it can describe the limits of what you think is acceptable treatment. Saying no to certain life-prolonging treatments should never mean that you have to do without treatments that relieve pain and provide comfort. |
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Can't I just rely on my family to make the right decisions? |
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Even with the best of intentions your family may not be able to follow through on your wishes. First, they may not know what those wishes are. Casual conversation on the topic won’t communicate the full range or seriousness of your intentions the way written directives do. Second, if you haven’t specifically designated a health care advocate most states have laws that will determine who should speak for you. These laws follow a formula of close kinship that might not reflect who you truly feel closest to or who you believe would best represent your wishes. Finally, as a practical matter, doctors are reluctant to move forward on the advice of family members if there are any signs of disagreement within the family. Your written words can end or outweigh such disagreement. That will help avoid a situation in which a hospital physician who doesn’t know you ends up making decisions about treatment that are not in line with your wishes. |
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How do I choose the person who will speak for me? |
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If the time comes when you can no longer speak for yourself, who should be your advocate? Many people will naturally select a spouse or adult child to fulfill this role, but there are important factors you should consider first. A family member who is not emotionally prepared for you to die might not be able handle the role in the way you would want them to. And even someone who is ready to act on your wishes might not have the assertive personality needed to speak on your behalf if others start objecting. Ideally, the person you choose as your advocate should be:
- willing to take on the role
- trusted by you
- in agreement with the choices stated in your objective
- prepared to fight for your wishes
- able to make decisions under stress
- able to separate his or her feelings from your wishes
- likely to be available when called upon
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Am I giving up control of all decision making? |
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No one can take control of your decisions about medical treatments as long as you are conscious and competent at the time a decision needs to be made. Neither your healthcare advocate nor the words of your written directive have any decision-making authority until the point that you are unable to communicate your wishes. And strict procedures, usually involving two or more health professionals, have to be followed to declare that you really are unable to communicate. So, for example, you can always say, "Yes, I want that treatment now," even if that goes against what is in your advance directive. |
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Will my health care providers really follow my advance directive? |
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There are two big barriers to having your wishes about treatment respected once you’ve completed your advance directive: a directive no one knows about and a directive that isn’t clear. If you do a thorough job of letting people know about your advance directive and make the effort to be as specific as you can be, you will be presenting your health providers with a clear expression of your wishes that they ought to follow. Talking through the issues with your doctor at the time you are filling out your advance directive is the best way to get reassurance that your wishes will be honored. |
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Who should I talk to before I write my advance directive? |
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The choices you make in composing your advance directive should be yours. But talking beforehand with those who are intimately involved in your life and your care can be very helpful. Discussions with your physician can give you a good sense of what kinds of decisions you may one day face and what outcomes certain treatments are likely to have. A sensitive member of your health team can talk with you about your fears, your goals and your expectations and you can use what you learn from those discussions to guide your choices about treatment. Family members may provide the same kind of help, and a three-sided discussion, including you, your doctor and a close relative, can go a long way toward bringing out all the important issues you need to make choices about. |
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Who should I talk to after I write my advance directive? |
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Once you’ve completed your advance directive, you should make sure people know about it. And wider distribution is better. A copy should go to
- your doctor for your medical record
- a hospital where you might be taken for treatment
- the person you designate as your healthcare advocate or proxy through the durable power of attorney document
- other friends and relatives you've discussed these issues with; close family members should definitely have a copy and should have discussed its contents with you
- your lawyer, if you have one
If you’re still living in your home and receiving care there, it’s a good idea to post a copy in an obvious place so it can be easily found in an emergency. If you’re no longer at home, the institution where you are residing should have a copy.
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How specific does my advance directive have to be?
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There is no way for you to cover every possible circumstance that you might find yourself in. In some cases you can be very specific, leaving no room for misinterpretation. "Do Not Resuscitate," for example, means that no attempt will be made to start your heart if it stops beating. But many situations can arise that you won’t foresee. So your advance directive should be specific where possible and express preferences and treatment choices more generally in other areas.
But even general statements should be as clear as you can make them. A phrase like "no heroic measures" can be interpreted differently by different people, and while it gives a sense of your wishes it might not be easy to apply. On the other hand, saying you don’t want your life prolonged by artificial means if you have no reasonable chance of regaining consciousness gives more specific direction, even as it leaves room for doctors and your advocate to determine when the time has come that there is "no reasonable chance."
The better you understand what’s meaningful to you, the likely progression of your illness and the usefulness of various treatments at various times, the more effective your advance directive will be in guaranteeing your choices are respected. |
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Do
I need a lawyer to do an advance directive? |
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A lawyer can certainly be helpful, but you don’t have to use one to create your advance directive. The interactive forms included with "Completing a Life" will guide you in sorting out the questions that need to be raised and organizing your responses to them. You can also ask a member of your health team about finding forms that are generally accepted in your state and about requirements for having your signature witnessed. Usually, your doctor cannot be a witness on these documents. |
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Is
a document drawn up in one state legal in others? |
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If you need medical treatment in another state and are unable to communicate your wishes about treatment, there is a good chance your advance directive will be honored as long as a valid copy is available. A number of states have policies that accept advance directives from another state as long as they fill the other state’s requirements. Even if the legal authority is unclear, health care providers will very likely take your written directive seriously as a true statement of your intentions. If you know that you will be spending time in another state, it’s a good idea to investigate how out-of-state directives are treated there. |
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How
often should I update my advance directive? |
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Review your advance directive periodically to make sure the wishes you expressed earlier still reflect your current views. As your medical situation changes, your attitudes about some issues in the directive might change too: what level of disability you feel you can live with, for example, or where you set the limits on aggressive therapy. When those changes occur, or the outlook for the future changes, or when your family or living situation changes, you should review the choices you’ve made in your advance directive. |
