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.

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

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

What is an advance directive?

An advance directive is a written statement of how you want your medical care provided if:

• You cannot make decisions for yourself
• You 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.

You may change or cancel your advance directive at any time.

All you must do is:

• Tell your doctor
• Give your 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 about 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. They can help if you cannot make your wishes known.

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:

• Health care agent
• Representative
• Proxy
• 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:

• Appointment of health care agent
• Durable power of attorney for health care
• 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.

Health care surrogates

A surrogate is an adult who can make health care decisions for you when you cannot make them for yourself. They are not the same as:

• Health care agent
• Attorney-in-fact
• Conservator
• Legal guardian

Having legal documents on file is always a better option than naming a surrogate.

Surrogates are needed when:

• No living will or advance directive in place
• There is not a health care agent or attorney-in-fact
• A health care agent or attorney-in-fact cannot be reached
• You cannot make decisions for yourself

You can choose a surrogate if you are able to do so. If you cannot, your doctor will choose one for you.

If you have someone you would like to be named as a surrogate, you can ask your doctor to put their name and contact information in your medical file.

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 make things easier for you and your family later.

Many people connect filling out advance directives to making decisions near the end of life. But you can fill out these documents at any time.

It's hard to talk about these issues. But there are benefits:

• 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 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.

If it's difficult for you to talk about, 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 for accuracy before signing. Most states require a witness or notary to be present when you sign.
  
• Provide copies to your:
  • Doctor
  • Hospital
  • Family members
• 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. Describe where the documents can be found.

Each state has its own laws regarding advance directives. 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. But many states will accept a proper form from another state.

Share your wishes with others

Studies show that an advance directive 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
• Your family

The more they know about your wishes, the better job they can do if the need occurs.

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