What is an Advance Directive?

    Most people want the end of their life to be as peaceful and as painless as possible. With our profit-driven  medical system, the more complicated medical cases  are given aggressive treatments and push them further way from a meaningful quality of life. How can you keep that from happening?

    We all have different wants and needs, and communicating those to your loved ones may be a good step towards ensuring that quality-of-life requirements are followed by your healthcare providers. This program helps you share your quality-of-life values clearly and without judgement. It also provides your family with important  information that will ease the finding of important documents when the time comes.

    In short, Advance Directives is a general term for oral or written instructions that give away information needed by your loved ones should you become incapable of stating them on your own. Advance directives is only a part of the process. Protecting your health and choices is a three-step process: 1.) deciding what you want; 2.) communicating your intentions so that others understand them; and 3.) committing your providers, family and health care agents to the acceptance of your choices.

    Why make an Advance Directive?

    You are the expert on your health care. Nobody knows better than you do about your health, history, your support system, what works best for you and what doesn’t.

    But what happens if you cannot make these important healthcare decisions because of an injury or illness? Your physician has lost his most important point-person! The advantage of having  an Advance Directive, then your “pre-recorded instruction” can still be a part of treatment planning.

    What happens without an AD?

    There are ways for treatment to happen if you don’t have a pre-written directive. For example, California law gives a list of people that doctors can contact to make decisions for you. But, the list is a “one-size-fits all” list…and it might not be in the order you would want.

    • Court-appointed guardian (if you have one)
    • Spouse (this includes separated but not yet divorced spouses)
    • Adult child(ren) (majority rules)
    • Parent
    • Adult siblings (majority rules)
    • Other relatives, in order of blood relationship
    • An interested adult, or “next friend”

    What if that list fits my needs?

    Even if the list is OK for you, are your care-takers aware of your more specific preferences of your wants and needs? For example, your doctor or loved ones might not realize your history of medication side-effects (that would be terrible but sometimes this happens). Or maybe there’s a particular doctor you would like them to contact and involve. You can help others involved in your treatment by providing written instructions in advance.

    Do I need to do anything specific for my Advance Directive to be legal?

    What you need –

    • Sign and date it yourself,
    • Have two adults witness you sign it, and
    • Have those two adults sign it to mention that they witnessed you sign it.
    • State laws vary. For example, if you’re in Indiana, New Hampshire, Kansas, Ohio, Oregon, or Texas, you might need to have it notarized

    What you don’t need – 

    • To use a compile various forms from multiple sources or sites,
    • Spend a lot of time and money and have an attorney draft one for you, or
    • Get your AD notarized (to be safe, check if your state requires this).

    Your AD is used only when you need it.

    An AD is a back-up plan for a time when you cannot make health care decisions for yourself.

    Individuals  might not be able to make health care decisions because of:

    • Physical injury – for example, being in a coma after a car accident, or
    • Illness – for example,
    • if a mental health crisis affects someone’s thinking, or
    • if another type of disease (e.g., dementia) affects someone’s thinking, or
    • if a treatment has a side effect that affects thinking.

    Who decides that I cannot make health care decisions?

    • The attending doctor must assess you in person and decide that you cannot make health care decisions for yourself,
    • A second doctor or a licensed clinical psychologist must assess you in person and independently decide that you cannot make health care decisions for yourself*.
    • The doctor must tell you of the decision and put it in your record.

    Having someone make decisions for you.

    You can pick someone to form decisions for you

    One thing you can do to plan for a time when you cannot make health care decisions is to pick someone to make the decisions for you. This person is called an agent. An agent has legal authority to make the decisions for you during the time that you cannot.

    • Who should I pick as an agent?
    • This is completely your decision. There are some important qualities to look for in an agent, like:
    • Can I have more than one agent?
    • You can pick one or more back-up agents. Having a back-up agent will help if your first-pick agent is not available or quits.

    Some people think about picking co-agents—two people to act at the same time with equal authority. But, co-agents can run into problems if they disagree.

    • Who can be my agent?

    • An agent needs to be at least 18 years old

    An agent should know you well, especially your health care preferences and values

    An agent should be someone that you trust to be your advocate

    An agent should be willing to be your agent

    An agent should be someone that is pretty easy to reach in an emergency

    What does it mean to give powers to your health care agent?

    Giving power to your agent. 

    You have the legal power to make decisions about your health care. You can make decisions about whether you want treatment or want to stop treatment. You can look at your medical records. You can sign forms at the doctor’s office. These are just a few examples of the many powers you have. But when you are unable to make informed decisions about your health care, you cannot use your powers very well or at all. Instead, your agent will need to have the powers so that he or she can take your place during that time. The powers on the advance directive form are the main ones that your agent might need.

    If you do not select an agent, the law will automatically appoint your spouse or closest blood relative to make health care decisions for you when you cannot. If this happens, the law grants all the powers below except visitation rights.

    You health care wants and values.

    One thing you’ll do to plan for a time when you cannot make health care decisions is to write details about what you want or otherwise for your treatment.

    You are the person who knows your health care history, values, and wants best. But once you are injured or ill and can’t make decisions, it’ll be very hard to share those important details.

    Writing those details down creates a “cheat sheet” for your agent and health care providers.