Advance Directives

Advance directive is the general term for several legal documents that tell your doctor and other people what your health care wishes are if:

• you become unable to make your own health care decisions; or
• you become terminally ill and unable to make your own health care decisions

What kind of advance directive is honored in your state depends on your state’s law. Some states have more than one directive. There is no one form that can be used in every state. Advance directives include:

• the Health Care Proxy (in MA, NY, MI)
• a Health Care Power of Attorney or Durable Power of Attorney for Health Care (in all states except MA, NY, MI)
• the Living Will (in all states except MA, NY, and MI; also called a Natural Death Declaration, Medical Treatment Declaration, Terminal Care Document, etc.)

Why are advance directives important?

Advance directives are an important part of planning for your health care because they put your values and wishes into a legally binding document or into the hands of someone you trust. If, because of an accident or illness, you cannot make decisions about your health care, your directive will help your health care provider to respect your wishes.

Without a directive, your doctor will turn to your spouse or family member who may have the legal authorityto consent to or refuse treatment for you. If there is a disagreement among the members of your family (or if you don’t have a family), your doctor will have to ask a court to name a legal guardian to make choices for you. If you enroll in a health plan, or are admitted to a hospital, nursing home, hospice, or home health agency, you will be given information about advance directives. But the choice to fill one out is yours alone. If you do complete one, and later change your mind, you can cancel it at any time.

If you decide to complete any advance directive, it is very important to talk with your doctor or other members of your health care team, your agent (the person you choose as decision maker), and with other people who may be involved with your care. The time to think and talk about your health care choices is before you need to depend on the directive.

How are the directives different?

A Health Care Proxy or Health Care Power of Attorney lets you choose someone you trust to make health care decisions for you. It becomes effective only if and when you become unable to make or communicate your own health care decisions. It lets your doctor and others know whom to ask to find out what your wishes would be in a particular situation. The person you choose, called your agent, will have full legal authority to make any health care decisions for you, including decisions about life-sustaining treatment if you wish. He or she can decide for you only when you cannot decide for yourself. Your agent must act according to your wishes or in your best interests.

Because the Health Care Proxy applies to all health decisions, and not just to decisions at the end of life, it is important for you to talk with your agent about issues important to you. For example, you might discuss how you would feel about having constant pain, what it would mean to you to have a permanent mental disability, or how your religious beliefs or moral code would guide your decisions. No one can predict what might happen in the future. But if the time comes when you must depend on another person to make decisions about your care, that person will have to know what is important to you in order to make the best choices for you.

A Living Will is a written statement you give to your doctor and family members. It declares that if you become terminally ill or there is no reasonable hope for your recovery, that you wish to avoid medical treatments that would only prolong the time of death and do not offer any hope of cure. Most documents say that you wish to be given all treatment necessary to keep you comfortable. Some Living Wills have checklists of treatments you do or don’t want in certain situations. Others have blanks where you can write in your specific wishes.

Where can I get the form(s) that are legal in my state?

You can often get the right form(s) from Newton-Wellesley Hospital, your health plan, hospice, nursing home, or home care agency, or from your own doctor, lawyer, or clergyperson. Many non-profit groups also have information and forms for low or no cost.

How do I complete a directive?

In most cases, advance directives are simple forms that do not contain technical or legal language. All documents require that you be a mentally competent adult (age 18 or over) who is signing the form freely and without pressure from anyone. Most require at least one and usually two witnesses. A notary is usually not necessary. You should give copies to your doctor or health care provider, your agent, family members, and other people who may be involved with your health care. You do not need a lawyer to complete an advance directive, but you may want to talk with a lawyer about advanced planning matters in general.