Advance Directives for Health Care Decisions

Sometimes, people are too ill to make health care decisions for themselves. This can happen very suddenly, so it is helpful to have an advance directive. An advance directive is a written statement of how you want medical care provided if, in the future, you cannot make decisions for yourself.

The choice to create an advance directive is up to you. The St. Jude staff wants you to know your options under the law. However, you are the one who must decide the best plan for your future care.

Types of advance directives

Advance directive options vary by state. In Tennessee they are set by the Tennessee Health Care Decisions Act, and there are 2 types of advance directives recognized:

Appointment of health care agent – This document lets you give someone else the power to speak for you. It is also called a durable power of attorney for health care or a health care proxy. You might hear many other names for the health care agent, such as representative, proxy, attorney-in-fact, guardian, or conservator. If you cannot make your own health care decisions because of injury or illness, your agent must make those choices for you. The health care agent is usually a relative or close friend.

Most often, the Appointment of Health Care Agent only goes into effect when you are unable to speak for yourself. However, Tennessee law does allow you the option of making your appointment take effect right away, even when you still can speak for yourself. You must make this desire known on the form. If you do not choose this option, the document will take effect only when you are unable to speak for yourself.

Advance care plan – An advance care plan is sometimes called a living will, a health care directive, or a health care declaration. This document lets you state what kinds of medical care you would or would not want if any of these happen to you: 1) you are in a permanent unconscious condition; 2) you have permanent confusion; 3) you become dependent in all activities of daily living; or 4) you are in the end stage of your illness.

It often refers to medical treatments that keep you alive. These measures can include:

• CPR (cardiopulmonary resuscitation) to restart your heart and breathing after they have stopped
• Assisted breathing using a ventilator
• Dialysis using a machine that does the work of your kidneys
• Nutrition or fluids given through IV or tube feeding
• Chemotherapy, radiation therapy, or other treatments that might prolong life
• Blood transfusions
• Antibiotics to fight infection

You can also make health care decisions for medical treatments to provide comfort and relieve suffering during advanced illness. Comfort care may include managing pain, anxiety, nausea, shortness of breath, or other symptoms. Your care team can help you understand decisions and care choices that you might include in advance care planning.

Completing the advance directive forms

The 2 types of advance directives can be signed as separate papers. Or sometimes, they are combined in a single form. A St. Jude social worker can give you a copy of the forms that meet the requirements of Tennessee law. If you like, your social worker can help you fill out these forms. Some states require your advance directive documents to be witnessed or have your signature notarized to make it effective. Your social worker can help you find a notary public or witnesses for a Tennessee form. Witnesses cannot be health care workers, your health care agent, or anyone who will inherit from you. Only 1 of the 2 witnesses can be a family member.

Non-written option for advance care planning

It is always best to have your advance directive choices stated in a signed, legal document. However, 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. 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 ask this person to make decisions if that person is available and willing.  

More options to discuss

DNR order – A do not resuscitate (DNR) order is a doctor’s written order that says, “If your breathing or heart stops, do not start CPR.” A DNR order can be part of an advance directive form or a separate written statement. The DNR can be included in a form called Physician Orders for Scope of Care (POST) that includes other information and can be shared with other hospitals and care centers that you might go to.

Donating organs – Some advance directive forms let you state your wishes about donating organs and tissues. It is important to let your family and health care agent know how you feel about donating organs and tissue for transplant to another person or for research.

Common questions