FOR MORE INFORMATION ABOUT THE FOLLOWING, SEE THE OTHER SECTIONS OF THIS DOCUMENT

"Advance Directives" and "Advance Health Care Directives" are the terms used to describe a group of legal documents which tell doctors and emergency personnel how you want to be treated medically even if you can't speak for yourself. 

It may be distressing to even think of writing an Advance Directive. However, if you do not execute such documents, you may be kept alive endlessly at your expense and against what you would have chosen for yourself. Someone will be appointed to speak for you who is not necessarily the person you would choose. As a general matter, even a person chosen to speak for you, including a Guardian, cannot end unwanted treatment unless you signed an Advance Directive.

If you only sign one Advance Directive, it is advisable to sign a Healthcare Power Of Attorney. The document appoints some to make decisions in the grey areas that reflect medical reality. You will also have someone to enforce those decisions.

Advance Directives are available for free for every state, can be written and executed without a lawyer's help and can easily be revoked or amended at any time. 

Types of Advance Directives

• Healthcare Power of Attorney: A legal document in which you choose another person known as your "agent" or "proxy" to make medical decisions on your behalf at any time you are unable to communicate yourself. You do not have to be terminally ill for the person to speak for you - just unable to communicate. (These documents are also called: Durable Power of Attorney for Healthcare, Healthcare Proxy, and Healthcare Agent)
• Living Will: A legal document which describes what you want when you are terminally ill in the situations which are spelled out in the document. (Also known as: Directive To Physicians, and Healthcare Directive):
• Do Not Resuscitate Order (generally referred to as a "DNR"): A legal document which states you do not want to be revived if your heart or lungs stop working. A DNR does not apply if you merely have difficulty breathing. It also does not prevent any other medical treatments. Some states require a DNR order to be reauthorized periodically.

Things to think about

• What medical care you do or do not want if you become unable to speak for yourself. and and there is little or no hope of recovery. 
  • One alternative is to think through what you want to happen in various situations such as being placed on a respirator if there is no hope of recovery. Your doctor can help clarify medical questions about alternatives people with your particular medical condition may face. 
  • If you would prefer not to focus on the specifics, then just think about in general. For instance, "If there is no hope for my recovery, discontinue all extraordinary measures and machines, (do) (do not) continue to feed me."
• Preferably, have both a Healthcare Power of Attorney and a Living Will. If you only execute one of these documents, a Healthcare Power of Attorney is preferable. A Healthcare Power Of Attorney appoints a person to act as Proxy to make decisions according to your wishes when things are not black and white. He or she also have the right to enforce those wishes. This is important because studies show that doctors and hospitals often ignore a patient's wishes as expressed in a Living Will. It is easier to ignore a piece of paper than a legally empowered person who is intent on having your wishes carried out. Also, Living Wills state what you desire in particular situations. They don't take into account all the questions that come up, or the reality that clarity is not the rule.
• When you execute a Healthcare Power of Attorney:
  • Choose the person to act as your Proxy with care. He or she will speak for you. The Proxy will also have to deal with your doctor, the hospital and possibly your family.
• Appoint an alternate in case your first choice cannot serve for any reason. 
• Discuss your general values wishes with your Proxy and alternate Proxy. An understanding of your values will help a Proxy determine what you would want in areas that have not been specifically discussed. If you have specific desires, tell your proxy and alternate. For example, you do not want to be placed on a respirator if there is little likelihood you will ever live without one.
• Avoid conflicts between your Healthcare Proxy and the terms of a Living Will by including appropriate provisions in each document.
• Advance directives are state specific. While a document properly executed according to the laws of your own state should be recognized in another state, there is no guarantee. Be sure your advance directives are legal in each state in which you live and/or are likely to be treated. If necessary, execute duplicate Advance Directives. (NOTE: Do not execute more than one original of your Will.)
• Have each document notarized even if it is not required in your state just in case you end up being treated in a state that requires notarization.
• Discuss your wishes with your family and your doctor who will be in charge of your care.
  •  No matter how many legal documents you execute, it becomes about the people involved. For example, you may have a perfectly valid Living Will, but if a spouse decides to fight your wishes, a time and money consuming court battle could follow.
• Let your proxy and family know that Survivorship A to Z provides information about how to enforce your directives if a doctor or medical facility do not go along.
  • If your proxy reviews the information about enforcing your wishes, he or she will have a better idea of what may be required.
  • If the proxy reviews information now about what to do "just in case," then the person will be able to act quickly if the need arises so you will not be subjected to treatments you do not want or to treatment for longer than you desire.
• If you go into a hospital, consider re-executing your documents, this time on the forms used by the hospital. In the event of an emergency, hospital personnel will know what to do if hospital forms are used. If you use your own form, they will likely have to seek advice from the hospital's legal team which could delay action.
• If you are Catholic, the church has affirmed your right to make your own health care decisions.
• Revisit your Advance Directives at least once a year. Revisit your Directives sooner is there is a significant decline in your health condition or if there is a change in relationship with your Proxy or alternate Proxy.
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Who to give a copy of your Advance Directives 

Advance Directives are only meaningful if the appropriate people know about them.

• Give a copy to your your primary doctor and each doctor who will oversee your care in what could be a life-threatening situation. This includes doctors who will perform an out patient procedure which involves anesthesia.
• Give a copy to each person you believe will help enforce your directives.
• If you execute a DNR directive, let caregivers know not to call 911 if you stop breathing outside a hospital.
• Carry a card in your wallet to let people know you have Advance Directives and where to find them.

Store the originals in a safe place which is easy to access. Let the people who are charged with enforcing your Advance Directives know where the originals are.

See other sections of this document for more information on each of the above subjects.

NOTE:  When considering documents to cover the "what ifs" also consider an Advance Directive for Mental Health which covers what happens if you become mentally incompetent and a Durable Power Of Attorney, which covers your finances.

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