BASIC FACTS ABOUT ADVANCE DIRECTIVES

If you go into a hospital, or move into an assisted living or nursing home, someone is sure to ask you if you have an advance directive. And you should have one! I will tell you why.

First, what is an advance directive?

Medical personnel use this term to mean any document that indicates what kind of care you might want or not want in the future. There are many types of advance directive: durable power of attorney for healthcare, living will, POLST (Physician’s Orders for Life-Sustaining Treatment), DNR (Do Not Resuscitate). New types of advance directive keep being developed as Americans struggle with the options available to them in their later years.

Why should I have one?

You need to have an advance directive in case a time arrives when you cannot speak for yourself (you’re too ill or you have lost your decision-making capacity).

If you have not indicated that you want certain limits to medical treatment, you will get everything that is possible for the medical team to do, that they think is necessary. This includes brain surgery, dialysis, a catheter in your heart, a breathing machine: anything necessary to keep you alive. The team will do everything because that is the default (and we should all be grateful for that as it’s better than the default being to do nothing). They cannot decide to withhold treatment from you, just because you are old, or have dementia, or even if you have a terminal illness, unless you say so. So, if you don’t want everything, you had better have an advance directive saying so!

Which advance directive should I have?

There is no question: you should have a durable power of attorney for healthcare. This document is the only one that is legally binding. The others have to be regarded as requests, or suggestions, or guidelines. This one is the one that wins over all the others, no matter what.

The durable power of attorney for healthcare (DPAHC) designates someone to speak for you, if you cannot speak for yourself. That’s it. That’s the legally binding part. No matter what you say you want in any other advance directive, it all falls to your designated agent in the DPAHC to make decisions when you can’t make them.

Your agent (or “proxy”) can be a relative, a friend, a spouse, a lawyer: anyone you can explain your wishes to, and who you believe will make decisions for you that are consistent with what you would have wanted yourself. Choose wisely!

You can download a blank DPAHC from the internet, or the hospital or nursing home or your doctor can give you a blank. You can fill it out yourself and then either have it notarized, or have two people witness it who are not named as your agents. If you prefer, you can have a lawyer draw one up for you, but this is not necessary or required.

Everyone (even young people) should have a DPAHC!