Writing an Advance Directive

Topic Overview

What is an advance directive?

An advance directive is a form that you fill out to describe the kinds of medical care you want to have if something happens to you and you can't speak for yourself. It tells your family and your doctor what to do if you're badly hurt or have a serious illness that keeps you from saying what you want. An advance directive can also be a talk you have with your family and your doctor about the kinds of care you want to have.

What are the different types?

There are two main types of advance directives:

  • A living will tells your family and your doctor what kinds of treatment you want to receive as you near the end of your life and if you can no longer speak for yourself. A living will is also called a treatment directive.
  • A medical power of attorney lets you name a person to make treatment decisions for you when you can't speak for yourself. This person is called a health care agent or health care proxy.

As long as you can still make your own decisions, your advance directive won't be used. You can stop or say “no” to treatment at any time.

How do you write an advance directive?

As you prepare your advance directive, you'll need to follow these four important steps:

  1. Get the living will and medical power of attorney forms for your state. Forms are different in each state, so be sure to get the right ones for where you live.
  2. Choose your health care agent. This should be a person you trust to make decisions for you.
  3. Fill out the forms, and have them witnessed as your state requires.
  4. Give copies to your family, your doctor, and your health care agent.

You can get the forms in a doctor’s office, hospital, law office, state or local office for the aging, senior center, or nursing home. You can also get them online at www.caringinfo.org or by calling 1-800-658-8898.

When you write your advance directive, think about the kinds of treatments that you do or don't want to receive if you get seriously hurt or ill.

Consider whether you want to:

  • Receive cardiopulmonary resuscitation (CPR) if your heart stops.
  • Be on a machine that pumps air into your lungs through a tube if you can't breathe on your own.
  • Be on a machine that cleans your blood if your kidneys stop working.
  • Be fed or get fluids through a tube if you can't eat or drink.
  • Take medicines to treat serious infections.

These are tough choices to make, but you don't have to make them alone. Take your time. Share your questions or concerns about what to include in your advance directive with your doctor or nurse, your lawyer, your family, or a friend.

What if you want to change what is in your advance directive?

You can change or cancel your advance directive at any time. Just fill out new forms and get rid of your existing forms. Or you can just let your family, your doctor, and your health care agent know about the change. If you change or create new forms, give everyone an updated copy. Don't just cross out or add new information unless it’s only to change your address or phone number.

Frequently Asked Questions

Learning about advance directives:

Things to consider:

Ongoing concerns:

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Decision Points focus on key medical care decisions that are important to many health problems. Decision Points focus on key medical care decisions that are important to many health problems.
  End of life: Should I stop treatment that prolongs my life?
  End-of-life care: Should I have artificial hydration and nutrition?
  End-of-life care: Should I receive CPR and life support?
  End-of-life care: Should I stop kidney dialysis?

Basic Types of Advance Directives

An advance directive is a legal form that describes the kinds of medical care you want to receive if something happens to you and you can't speak for yourself. It tells your family and your doctor what to do if you're badly hurt or have a serious illness that keeps you from saying what you want.

The two main types of advance directives are a living will and a medical power of attorney.

Living will

A living will makes clear the kinds of medical care you want to receive if you get seriously hurt or ill and can't make your own decisions. It describes your choices for care and how you want them carried out if you're near the end of your life or are in the hospital with a serious illness. If you get better and can speak for yourself again, you can stop or say “no” to treatment at any time. If you have a living will, your choices will be honored. A living will is also called a treatment directive.

Medical power of attorney

A medical power of attorney lets you name a person to make treatment decisions for you when you can't speak for yourself. This person is called a health care agent or health care proxy. Some states may limit what your health care agent can decide for you. In a few states, he or she can speak for you right away and at any time that you don't want to make choices for yourself. He or she can also use your living will and what he or she knows about you to help guide your care.

When you choose a health care agent, select a person you trust to make medical decisions for you. For more information, see the topic Choosing a Health Care Agent.

As long as you can still make your own decisions, your advance directive won't be used. You can change or cancel it at any time. Your health care agent will only make choices for you if you can't or don't want to decide for yourself.

Why an Advance Directive Is Important

An advance directive is important in case something happens to you and you can't speak for yourself. It gives you control over your own medical care if you're badly hurt or if you develop a serious illness and you can't make your own medical decisions. It’s also very important for your family and your doctor. They can use the information in your advance directive to make choices for you if you can't make them yourself. A living will and a medical power of attorney are the main types of advance directives.

A living will makes clear the kinds of medical care you want to receive if you get seriously hurt or ill and can't make choices for yourself. This can include whether you want to be kept alive by machines and/or medicines as your health gets worse and there is little chance that you'll get better.

A medical power of attorney lets you name a person to make treatment decisions for you when you can't speak for yourself. This person is called a health care agent or health care proxy.

If you've done an advance directive, share it with your family, your doctor, and your health care agent. Don't assume that they know what you want if you don't have one. This is a time when you can answer any questions they may have and be sure that they know what you want. An advance directive takes the burden away from your family so that they don't have to decide what is best for you. And it makes sure that your wishes are met.

If you don't have a living will and a health care agent, a person other than your family member may decide what kind of care you receive. A decision may be made by a doctor who doesn't know you, or it may even be made by the courts. In some states, you need to make clear and give permission in your advance directive that you don't want to be fed through a tube or receive other kinds of life support.

A living will isn't for everyone. Some people choose not to have one for religious or spiritual reasons. If you don't want to have one, tell your family and your doctor. They should respect your wishes.

Preparing an Advance Directive

Get started

If you've decided to write an advance directive, you've taken an important step to make sure that your health care wishes are met.

When you write your advance directive, think about the kinds of treatments you do or don't want to receive if you get seriously hurt or ill. If you have questions and need help to get started, see what things to include in an advance directive for some ideas.

Involve your family, your health care agent, and your doctor as you write your advance directive so they'll know what you want. If something happens that you didn't plan for, they'll have a better idea of how you would want to handle it.

There are many choices to make when you write your advance directive. Some of these have to do with whether you want certain treatments.

To help you decide which medical treatments you do or don't want to receive, see:

Click here to view a Decision Point. Should I receive artificial hydration and nutrition?
Click here to view a Decision Point. Should I receive CPR and mechanical ventilation?
Click here to view a Decision Point. Should I stop kidney dialysis?
Click here to view a Decision Point. Should I stop receiving life-prolonging treatment?

These are tough choices to make, but you don't have to make them alone. Look to your family, your doctor, and your friends for help and support.

Write down your wishes

As you prepare an advance directive, you'll need to follow these four important steps:

  1. Get the living will and medical power of attorney forms for your state.
    • Forms are different in each state, so be sure to get the right ones for where you live.
    • You can get the forms in a doctor’s office, hospital, law office, state or local office for the aging, senior center, or nursing home.
    • You can also get the forms online from Caring Connections at www.caringinfo.org, or by calling 1-800-658-8898.
    • Your state may offer an online registry. This is a place you can store your advance directive online so authorized healthcare providers can find it right away.
    • Aging With Dignity has a form called “Five Wishes” that can be used in many states. It combines a living will and a medical power of attorney in one form. It also lets you write down how you want people to treat you and what you want your family to know. You can order the "Five Wishes" form online at www.agingwithdignity.org or by calling 1-888-594-7437.
  2. Choose a health care agent. This should be a person you trust to make decisions for you. For more information, see the topic Choosing a Health Care Agent.
  3. Fill out the forms, and have them witnessed as your state requires.
  4. Keep the original form in a safe but accessible place, such as in your desk with other important papers. Let your loved ones know where you keep your forms. Don't keep it in a safe deposit box unless others can get to it. On each copy, write down where the original form is kept. Give copies to:
    • The person that you choose for your agent and any alternate agents.
    • Your lawyer.
    • Your doctor or doctors.
    • Family members.
    • Any other person who may be called if you have a medical emergency.

You can change or cancel your advance directive at any time. Just fill out new forms and get rid of your existing forms. Or you can just let your family, your doctor, and your health care agent know about the change. If you change or create new forms, give everyone an updated copy. Don't just cross out or add new details unless it’s only to change your address or phone number.

Other Places To Get Help

Organizations

Aging With Dignity
P.O. Box 1661
Tallahassee, FL  32302-1661
Phone: 1-888-5-WISHES (1-888-594-7437)
E-mail: fivewishes@agingwithdignity.org
Web Address: www.agingwithdignity.org
 

Aging With Dignity is a private, non-profit organization best known for its Five Wishes advance directive, which helps individuals and families better plan for and receive the kind of care they want during times of serious illness. Five Wishes is a document that helps you express how you want to be treated if you are seriously ill and not able to speak for yourself. All of a person's needs are addressed: medical, personal, emotional, and spiritual.


AHA's (American Hospital Association) Put It In Writing
One North Franklin
Chicago, IL 60606-3421
Phone: 312-422-3000
Web Address: www.putitinwriting.org/putitinwriting_app/index.jsp
 

This Web site from the American Hospital Association has information on writing an advance directive, self-help worksheets, and other resources. The site also offers a brochure ("Put It In Writing"), a glossary of terms, and questions and answers. There is also a wallet ID card that can be downloaded, printed, and filled out to carry in your wallet.


American Academy of Family Physicians
P.O. Box 11210
Shawnee Mission, KS  66207-1210
Web Address: www.familydoctor.org
 

The American Academy of Family Physicians offers information on adult and child health conditions and healthy living. Its Web site has topics on medicines, doctor visits, physical and mental health issues, parenting, and more.


Caring Connections
1700 Diagonal Road
Suite 625
Alexandria, VA  22314
Phone: 1-800-658-8898 help line, 1-877-658-8896 multilingual line
(703) 837-1500
Fax: (703) 837-1233
E-mail: caringinfo@nhpco.org
Web Address: www.caringinfo.org
 

Caring Connections, a program of the U.S. National Hospice and Palliative Care Organization (NHPCO), seeks to improve care at the end of life. Caring Connections provides free resources, including educational brochures, advance directives and hospice information, and a toll-free help line for people looking for quality end-of-life information.


References

Other Works Consulted

  • American Health Lawyers Association (2005). A Guide to Legal Issues in Life-Limiting Conditions. Available online: http://www.healthlawyers.org.
  • Cordts GA, et al. (2007). Care at the end of life. In LR Barker et al., eds., Principles of Ambulatory Medicine, 7th ed., pp. 192–207. Philadelphia: Lippincott Williams and Wilkins.
  • Gomez D (2002). Advance directives and CPR. In BM Kinzbrunner et al., eds., 20 Common Problems in End-of-Life Care, chap. 15, pp. 297–311. New York: McGraw-Hill.
  • Reichman WE, et al. (2004). Legal, ethical, and policy issues. In DG Blazer et al., eds., Textbook of Geriatric Psychiatry, 3rd ed., pp. 515–528. Arlington, VA: American Psychiatric Publishing.
  • Tulsky JA (2000). Advance care planning. In J Sugarman, ed., 20 Common Problems: Ethics in Primary Care, chap. 20, pp. 255–266. New York: McGraw-Hill.

Credits

Author Bets Davis, MFA
Editor Susan Van Houten, RN, BSN, MBA
Associate Editor Pat Truman, MATC
Primary Medical Reviewer Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer Shelly R. Garone, MD - Palliative Care
Last Updated March 4, 2010

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