Adopt Advance Medical Directives for Health Care

What are advance medical directives?
At some point in your life, you may become incompetent; that is, lacking the mental capacity to make or communicate responsible health-care decisions for yourself. Without directions to the contrary, medical professionals are generally compelled to make every effort to save and sustain your life. Depending on your attitude toward various medical treatments and your views on the quality of life, you may wish to take steps now to control your future health-care decisions. The laws of your state may allow you to do so by adopting one or more advance medical directives. Advance medical directives allow you to manage your future medical care. 

There are three main types of advance medical directives: (1) a living will, (2) a durable power of attorney for health care (DPAHC) (also called a health-care proxy), and (3) a do not resuscitate (DNR) order. Each of these has unique characteristics, and each one is useful under specific circumstances. You may find that one, two, or all three advance medical directives are necessary to express all your wishes regarding medical treatment.

How do you decide whether to execute advance medical directives?
Your expectations regarding future medical care needs and your personal attitude will help determine whether you should execute one or more advance medical directives. Some of the questions you might wish to consider are:
  • Do I have any strong feelings or wishes regarding my future medical treatment?
  • What is my attitude toward life-sustaining treatments, such as artificial respiration and intravenous feeding? Are there circumstances under which I definitely would, or would not, want such treatment?
  •  Is there someone I trust to make medical decisions on my behalf?
  • What are my wishes regarding day-to-day care or medication?
  • Do I want cardiopulmonary resuscitation (CPR) to be performed if my heart or breathing stops?
By answering these questions, you should begin to get a feeling for whether you should execute advance medical directives and which one(s) might be appropriate for you.

What are your options?
  • Living will — A living will allows you to approve or decline certain types of medical care, even if you will die as a result of the choice. However, in most states, living wills only take effect under certain circumstances, such as terminal injury or illness. Generally, one can be used only to decline medical treatment that "serves only to postpone the moment of death." You may have a living will that is not binding but serves only as an expression of your wishes.
  • Durable Power of Attorney for Healthcare (DPAHC) — Using a DPAHC (called a health-care proxy in some states), you appoint a representative to make medical decisions on your behalf. This representative has the authority to consent to or decline medical treatments for you. You decide how much power your representative will have.
  • Do Not Resuscitate (DNR) — A DNR is a doctor's order that tells all other medical personnel not to perform CPR if you go into cardiac arrest. There are two types of DNRs. One is effective only while you are hospitalized. The other is used by people outside the hospital.
What else should you know about advance medical directives?
  • A living will generally cannot be used to express your wishes regarding day-to-day treatment. For example, a living will containing a request not to be placed in a nursing home would not be enforceable in most states.
  • Some of the shortcomings of a living will can be corrected by using it in conjunction with a DPAHC, which allows your representative to make both major and minor decisions on your behalf.
  • A DNR is the only advance medical directive specifically intended for use in an emergency.
  • If you spend a significant amount of time in a state other than where you live, you may want to research that state's laws on advance medical directives. These laws vary considerably from state to state.
  • Review your advance medical directives periodically to ensure they reflect your current wishes and attitude.
  • If you have multiple advance medical directives, make sure your instructions are stated consistently throughout. In many states, the most recent document prevails in case of a conflict.
Example: Martha, age 68, wants to maintain control of her future medical care decisions in case of incompetence. With a little research, Martha learns that living wills, DPAHC, and DNR orders are all permitted in her state. Martha decides to utilize all three advance medical directives to convey her wishes regarding medical care.

Example: Among other things, Martha states in her living will that she does not wish to be kept alive by artificial means, such as intravenous feeding or artificial respiration. Martha uses her DPAHC to appoint her son, Frank, as her representative. She gives Frank the power to act in her best interest if Martha becomes incompetent. Martha also has her doctor issue a DNR order. Martha provides her doctor with copies of these documents and periodically updates them to reflect technological advances and changes in her own attitude.

Example: Five years later, Martha develops Alzheimer's disease. Her condition deteriorates and eventually she is unable to make decisions for herself. As her representative, Martha's son, Frank, takes control of Martha's medical decisions and hospitalizes his mother. Frank approves the use of a newly developed experimental drug, which helps to slow Martha's rapid decline. Ultimately, even the drug no longer helps and Martha becomes weaker and weaker. Her breathing becomes extremely erratic and labored, but because of her living will, Martha is not placed on a respirator. One day, Martha's heart fails. In accordance with her DNR, CPR is not attempted.

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