Advance Health Care Directive
It is often difficult for individuals to think about the care and treatment they want in the event they are incapable of making their own health care decisions. You may unexpectedly be in a position where you cannot speak for yourself - such as an accident or stroke - and be unable to make treatment decisions. If this happens, you want to be assured that appropriate decisions are made. You can define in advance what medical treatment you prefer. If you are 18 years of age or older and of "sound mind", you can make an advance directive.
Advance Directives are usually written documents that state what kind of medical care you want if you were too ill or became unable to express your wishes for care. Advance directives speak for you when you are unable to do so because it tells others the care and treatments you do or do not want and/or who will make health care decisions for you when you cannot express your wishes.
Advanced directives include:
- Living will – a written statement in which you specify what kind of health care you do or do not want to receive
- Durable Power of Attorney for Health Care (DPAHC) – a form that allows you to appoint another person to make health care decisions for you if you are not capable of making them yourself
- Physician’s Order for Life-Sustaining Treatment (POLST) – California allows for physician’s order that outlines a plan-of-care reflecting a patient’s wishes concerning care at life’s end
Who Should I Designate as My Agent?
Because your designated agent will make decisions for you based upon what he or she knows about you and thinks is best for you, it is important to choose someone who knows you well and to discuss your treatment preferences with him or her. You should choose someone who is willing to make the decisions you request in your advance directive. Your agent cannot be your doctor.
Here are some questions to help you begin discussing your thoughts, values, and desires for end-of-life care. What are your wishes? What is most important to you?
- Living to 100 or quality of life?
- Is it important to you to live your last days of life at home or in a hospital?
- Do you want life-prolonging measures?
- What treatments would you want and not want?
- Who do I want to speak on my behalf if I cannot speak for myself?
- Would you want to be kept alive with tube feedings?
What If I Change My Mind?
You can cancel or replace a living will or a power of attorney for healthcare at any time. The different ways you can do this are explained on the forms you complete when you make a living will or appoint a power of attorney for healthcare. A POLST can be changed as long as you have the capacity to request alternate treatments. If you lack decision making capacity, your surrogate may also request a change in conjunction with your physician.
Where Should I Keep My Advance Directive?
Without a copy of your advance directive, it cannot be used as a guide for your treatment. Your family members and your lawyer, if you have one, should know you have made an advance directive and have a copy. You should also ask your physician to make your advance directive part of your permanent medical record. You should make several copies of your advance directive. Find a safe place where you and others can easily find your copy. (Do not keep it in a safe deposit box.)
What Happens If I Don't Make an Advance Directive?
You will receive medical care regardless of whether or not you have an advance directive. However, there may be a greater chance you will receive the types of care and treatments you want if you have an advance directive. Usually your spouse is your legal surrogate to make decisions on your behalf. If you do not have a spouse, surrogate decision making falls to other family members.
Your physician or other health care providers can help you understand your health needs and the options for treating these needs. They can answer questions about advance directives.
The Institute for Healthcare Advancement provides an easy-to-read and easy-to-understand advance health care directive form on their website, which is also available in multiple languages. Please visit their website to download the form.
Advanced directive kits are available from the California Medical Association website www.cmanet.org or call them at their toll free number, 1-800-882-1262. Kits are also available in Spanish.