How to Plan Health Care Decision Making

Sometimes, adults are not able or willing to make decisions for themselves because of a mental or physical condition.

This situation can happen suddenly. That is why it is helpful to have an advance directive.

What is an Advance Directive?

An advance directive is a written statement of how you want your medical care provided if, in the future, you cannot, or in some cases, do not wish to, make decisions for yourself.

Why Advance Directives Are Important

Filling out advance directives gives you control over your future health care.

Serious health care decisions can be hard to make even when people are healthy. But if they are already seriously ill, such decisions can seem overwhelming.

You may change or cancel your advance directive at any time. All you have to do is tell your doctor or give the doctor a copy of the new form. The doctor will make note of the change in your medical record. Also, make sure your family and person who you have designated to make health care decisions know about the change.

Keep a copy of the document with your important personal papers.

Types of Advance Directives

In general, there are two main types of advance directives:

• Living wills or advance care plans, which address the kind of care you might or might not want
• Medical powers of attorney and designation of health care agents, which allow you to select someone else to make decisions for you.

Specifics might vary by state and country law.

Living Will or Advance Care Plan

Living wills and advance care plans allow you to say what kinds of care you would or would not want if you cannot make your wishes known at the time. This plan may also be called a health care directive or health care declaration.

A living will often refers to life-sustaining measures. This means advanced, high-tech care that can keep you alive past the time when you might normally die.

These measures may include:

• CPR (cardiopulmonary resuscitation) – Urgent treatment to restart your heart and breathing after they have stopped
• Ventilator – A machine that breathes for you
• Dialysis – A machine that does the work of your kidneys
• Tube or IV feeding – If you are no longer able to swallow
• Drug and radiation therapy
• Blood transfusions
• Antibiotics – Drugs to fight infection

Medical Power of Attorney or Health Care Agent

A medical power of attorney or designation of health care agent allows you to name the person you would like to make health care decisions on your behalf. This person may be called your health care agent, representative, proxy, or attorney-in-fact. Although these names mean the same thing when it comes to health care, each may have different rules or requirements.

If you cannot make your own health care decisions, this person may make those choices for you. The health care agent is usually a relative or close friend.

This type of advance directive may also be called an appointment of health care agent, durable power of attorney for health care, or a health care proxy.

In some states, the document can take effect right away even when you still can speak for yourself. You can make this desire known on the form.

When to Complete Advance Directives

Ideally, these documents should be completed when you are healthy. Making these choices when you are in good health can reduce the burden on you and your loved ones later on.

Yet many people connect filling out advance directives to making decisions near the end of life. But you don’t need to wait until being diagnosed with a serious illness to think about your wishes for care.

It's hard to talk about these issues. But there are benefits to talking to the people close to you about the kind of care you want:

• Your wishes are known and can be followed.
• It often comforts family members to know what you want.
• It saves family members from having to bring up the subject themselves.
• You may also gain peace of mind. You are making the choices for yourself instead of leaving them to your loved ones.
• It can help you and your loved ones worry less about the future and live each day to the fullest.

If talking with your family and other loved ones is too difficult, consider having a family meeting and inviting a social worker or chaplain to guide the discussion.

Reviewing and Signing Advance Directives

Your attorney or a social worker at your care center can help you locate the proper forms to fill out. State-specific advance directives can be downloaded from the National Hospice and Palliative Care Organization.

Once you have completed them:

• Review them with a member of your health care team or other health care professional for accuracy before signing. Most states require a witness or notary to be present at the signing of the documents.
• Provide copies to your doctor, hospital, and family members after you sign them.
• Store copies in a safe, accessible place.
• Consider keeping a card in your wallet with a written statement declaring you have a living will and medical power of attorney and describing where the documents can be found.

Each state has its own laws regarding advance directives. Therefore, special care should be taken to follow the laws of the state where you live or are being treated. A living will or medical power of attorney that is accepted in one state may not be accepted in another state, although many states will accept a proper form from another state.

Non-written option

It is always best to have your advance directive wishes stated in a signed, legal document. If you are not able to appoint a health care agent in writing, you can still tell your doctor who you would want to speak for you should the need arise. In many states, the person you choose is called your surrogate. Your doctor will write the name of the surrogate in your medical chart. In the future, if you are unable to make health care choices for yourself, the medical staff will call on this person to make those decisions if that person is available and willing to make decisions.

Share Your Wishes with Others

Studies show that an advance directive, by itself, often does not answer all the questions that can come up. If something happens to you, your care will depend on your health care agent, your doctor, and your family. The more they know about your wishes, the better job they can do if the need occurs.