Writing an Advance Directive

Topic Overview

What is an advance directive?

An advance directive is a legal document that helps ensure that your health care wishes will be respected if you become unable to speak or otherwise communicate. In the absence of a written document, sometimes an advance directive may be an oral communication, where you express your wishes for care verbally to your family members or health care agent. An advance directive may become important if you are severely injured or develop a serious illness that prevents you from actively participating in decisions about your medical care.

What are the different types?

There are two main types of advance directives:

• A living will, also called a treatment directive, documents personal wishes about end-of-life medical treatment in case decision-making or communication abilities are lost.
• A medical power of attorney is a legal document that lets you appoint someone (usually called a health care agent or health care proxy) to make medical treatment decisions for you not only at the end of life but any time you are unable to speak for yourself.

How do I write an advance directive?

There are four important steps in preparing an advance directive:

1. Get the appropriate living will and medical power of attorney forms for your state.
2. Choose someone to be your health care agent.
3. Complete the forms and have them notarized or witnessed as your state requires.
4. Give copies to your doctor, your family, and your health care agent.

Forms vary from state to state. You can generally get the right forms for your state in a doctor's office, hospital, law office, state or local office for the aging, senior center, or nursing home. You can also get these forms online at www.caringinfo.org or by calling 1-800-658-8898.

If you do not understand the forms, ask a doctor, nurse, lawyer, family member, or friend to help you fill them out.

What if I change my mind about anything in my advance directive?

You can change or revoke your advance directive at any time by completing new forms, destroying your existing forms, or simply telling your caregivers. If you change or create new forms, remember to inform everyone. Do not just cross out or add new information unless it is simply a change of address or phone number.

Frequently Asked Questions

Health Tools

Health tools help you make wise health decisions or take action to improve your health.

	Decision Points focus on key medical care decisions that are important to many health problems.
	Should I receive artificial hydration and nutrition?
	Should I receive CPR and mechanical ventilation?
	Should I stop kidney dialysis?
	Should I stop life-prolonging treatment?

Basic Types of Advance Directives

Having an advance directive means that you have written down information that can guide others into making medical decisions and providing care should you become unable to communicate your wishes. A living will and a medical power of attorney to designate a health care agent are the two main types of advance directives.

Living will

A living will, also called a treatment directive, outlines your general preferences for health care and medical treatment, such as what measures you would like taken if you are hospitalized with a serious illness. You have the right to stop or refuse any medical treatment, even if it will result in your death. If you have a living will, this right is protected even if you are no longer able to speak for yourself.

Medical power of attorney

This is a legal document that lets you choose and appoint someone, usually called a health care agent or health care proxy, to make medical treatment decisions for you not only at the end of life but any time you are unable to speak for yourself. Laws vary from state to state. There are restrictions in some states that limit the agent's authority. In a few states you can designate a health care agent to speak for you immediately and at any time that you choose not to make your own medical decisions. Your health care agent can use the information in your living will as well as what he or she knows about you personally to make decisions about your medical treatment.

For more information, see the topic Choosing a Health Care Agent.

As long as you can make your wishes known about medical treatment, your advance directive will not be used. You can change or revoke your advance directive at any time. Your health care agent will make decisions for you only if you choose not to make them yourself or if you become unable to make decisions and speak for yourself.

When an Advance Directive Is Crucial

An advance directive is crucial for having control over your own medical care if you become unable to make decisions or cannot communicate your wishes. It is also a way to share your feelings with your family and help them if they ever need to make decisions about your medical treatment. An advance directive may become important if you are severely injured or develop a serious illness that prevents you from actively participating in your medical care. A living will and a medical power of attorney, which assigns a health care agent, are the two fundamental types of advance directives.

A living will, also called a treatment directive, outlines your general preferences for medical treatment if you develop a terminal or irreversible illness or injury and are unlikely to regain the ability to make decisions. In these circumstances, a living will can document your wishes about issues such as life-sustaining treatments and pain management.

Do not assume that your doctor and family will know your preferences if you have not prepared an advance directive or discussed your preferences with them. Communicating about these documents can help you feel assured that your wishes are understood. It can also help prevent your loved ones from potentially having to carry the burden of making difficult decisions on your behalf without knowing what you want.

Without a living will and a health care agent, decisions about your medical care may sometimes be made by a doctor who does not know you, or even by the courts, rather than by your family or your health care agent. In several states, you have to state your permission in your advance directive to not use or to withdraw feeding tubes

It is especially important to have a living will and a health care agent if you would not want to be kept alive by artificial nutrition and hydration, such as a feeding tube. In several states, you have to give your permission in your advance directive to not use or to withdraw feeding tubes.

Some people are not comfortable with having an advance directive—in particular, a living will. This may be because of religious or spiritual reasons or other beliefs and values. If you choose not to have a living will, your family and your doctor should respect your decision.

Preparing an Advance Directive

Getting started

Do not wait for your doctor to bring up the subject of an advance directive. To help yourself develop a clear idea of your wishes, think about the kinds of medical treatments you would or would not want in different situations. See the checklist for writing an advance directive to help guide you through some of the things you may want to consider.

Involve your family, your health care agent, and your doctor in this process so they become familiar with what you want. If a situation arises that you did not anticipate, your family, health care agent, and doctor will have a better idea of how you might like to handle it.

For more information on thinking about what medical treatments you want, see:

• Should I receive artificial hydration and nutrition?
• Should I receive CPR and mechanical ventilation?
• Should I stop kidney dialysis?
• Should I stop receiving life-prolonging treatment?

Documenting your wishes

There are four important steps in preparing an advance directive:

1. Get the right forms for your state. You can get forms from:
   • A doctor's office, hospital, law office, state or local office for the aging, senior center, or nursing home.
   • A nonprofit organization called Caring Connections at www.caringinfo.org. Its Web site has free forms for every state. Or you can call the help line at 1-800-658-8898.
   • A nonprofit organization called Aging With Dignity at www.agingwithdignity.org. This organization offers a form called Five Wishes that can be used in many states. Five Wishes is easy to understand and combines a living will and power of attorney into one form. It also has you fill out things like how you want people to treat you and what you want your loved ones to know. Visit the Web site to see if you can use Five Wishes in your state or to order a form for a small fee. You can also order Five Wishes by calling 1-888-594-7437.
2. Choose someone to be your health care agent. For more information, see the topic Choosing a Health Care Agent.
3. Complete the forms and have them notarized or witnessed as your state requires. When filling out these forms, it may be helpful to organize your thoughts by using a checklist for writing an advance directive.
4. Give copies of your advance directive to your doctor, your family, and your health care agent. Keep the original document in a safe place, but do not keep it in a safe deposit box unless others have access to it. On each copy of the advance directive, write the location of the original form.

You can change your advance directive at any time by completing and distributing new forms. Do not just cross out or add new information unless it is simply a change of address or phone number. Be sure to discuss the changes that you have made with your health professional and family members.

Other Places To Get Help

Organizations

Related Information

• Care at the End of Life
• Choosing a Health Care Agent
• Hospice Care