Consumer Guide: End-of-Life Planning

Advance Directives: Planning Your Medical Care

What is an Advance Directive?

An advance directive is a legal document that outlines your wishes regarding medical treatments and care. It is crucial to plan for end-of-life situations, ensuring that your preferences are known and respected. This document is particularly important because it helps guide medical professionals and your loved ones in making decisions when you are unable to communicate your own wishes.

Types of Advance Directives

1. Living Will: This document specifies the medical treatments you would want or not want in the event you become incapacitated. It can detail your preferences for life-sustaining treatments, such as the use of a ventilator or artificial nutrition and hydration.

2. Durable Power of Attorney for Health Care (DPOA): This directive appoints a health care agent, also known as a proxy or surrogate, who will make decisions for you regarding your medical care if you are incapacitated or unable to make these decisions yourself.

Importance of Advance Directives

• Autonomy and Control: Advance directives help maintain your autonomy by ensuring that your wishes are respected and carried out. This can greatly reduce stress and anxiety for your family and caregivers.

• Reducing Uncertainty: These documents provide clarity regarding your preferences, which can alleviate the burden of decision-making for your loved ones during a crisis. It also reduces the likelihood of disputes and conflict over medical care.

• Reducing Suffering: By planning ahead, you can avoid unnecessary suffering and ensure that your care aligns with your values and wishes. This can lead to a more peaceful and dignified end of life.

How to Create an Advance Directive

1. Reflect on Your Values and Wishes: Think about what matters most to you at the end of life. Consider your values, what you would want to achieve, and what you would want to avoid. This reflection can guide your decisions about future care and medical treatment.

2. Consult with Your Doctor: Discuss your advance care planning with your doctor. They can help you understand the types of life-sustaining treatments available and provide guidance on how to document your wishes. This conversation can also help you clarify your decisions and ensure that your wishes are accurately reflected in your advance directive.

3. Choose Your Health Care Agent: Select a person you trust to make decisions on your behalf if you are unable to do so. This person should be familiar with your values and wishes and willing to act in your best interest.

4. Document Your Wishes: Write down your wishes in a clear and concise manner. Ensure that your document is signed and dated, and consider having it notarized or witnessed if required by your state.

Steps to Follow

1. Get Information: Research the types of life-sustaining treatments available and decide which ones you would want or not want.

2. Make Decisions: Decide what treatments you would want or not want. Be specific about the circumstances under which you would want each treatment.

3. Share Your Wishes: Discuss your end-of-life wishes and preferences with your loved ones. This helps ensure that everyone is aware of your wishes and can act accordingly in the event you are unable to communicate them.

Why You Need Advance Directives

1. Medical Uncertainty: Medical science is constantly evolving, and new treatments and technologies emerge regularly. By planning ahead, you can ensure that your care aligns with your values and wishes, regardless of the medical advancements that may occur.

2. Family and Caregiver Burden: Advance directives can reduce the emotional and psychological burden on your loved ones by providing clear guidance on your wishes. This can also help them feel more confident in their decision-making.

3. Personalized Care: Planning ahead allows you to tailor your care to your specific needs and values. This can result in more personalized and effective medical treatment, as your wishes are respected and implemented.

Additional Considerations

1. Review and Update: Advance directives should be reviewed periodically, especially after significant life events such as a move or change in health status. This ensures that your wishes remain current and accurate.

2. DNR and DNI Orders: While an advance directive includes your wishes regarding resuscitation and intubation, it is still advisable to establish do-not-resuscitate (DNR) and do-not-intubate (DNI) orders at each hospital or healthcare facility admission. This ensures that your preferences are clearly documented and available in your medical record.

Conclusion

Advance directives are essential tools in ensuring that your end-of-life care aligns with your values and wishes. By creating and updating these documents, you can maintain control and reduce uncertainty for your loved ones. It is crucial to engage in meaningful conversations with your doctor and health care agent to ensure that your wishes are accurately documented and respected.

Resources

• Mayo Clinic: Living Wills and Advance Directives for Medical Decisions
• Bioethics Today: My Advance Directive: A Narrative Approach
• National Institute on Aging: Advance Care Planning: Advance Directives for Health Care
• Our Life Celebrations: Writing Your End-of-Life Plan and Advance Directive
• NCBI: Advance Directives