What is an Advance Directive?

An advance directive is a document that clearly outlines directions to healthcare providers about treatment choices in specific circumstances. There are two types of advance directives – a durable power of attorney and living will. In the durable power of attorney for health care you can name a patient advocate who will act on your behalf and carry out your wishes. A living will establishes your wishes in writing but does not name a person to act as your advocate.

Advance Directives can present complicated questions making it extremely important to understand how it will be carried out.

For example, an advance directive may state that if the person lapses into unconsciousness they will receive no food, water, medications or IVs. While the directive may be clear, it’s important to consider what happens once it is implemented. Will your loved one appear to rally, and if so, what will you do? Will they respond to pain even if unconscious? How long will it take them to pass away when treatment, food and water are no longer administered?

These questions may be difficult to ask, and the answers uncomfortable, but knowing what lies ahead will help you to prepare for that time. The answers can help you to think through what you can manage and help you develop strategies to help you cope. You may need the support of friends, other family members, clergy and medical staff in very specific ways. Planning ahead for your own needs will enable you to enlist support when it is most needed.

Advance directives can be signed as long as the person is deemed "competent". All that this means is that your loved one must be capable of understanding their condition and the results of their decision. It is not necessary to have this document but it is definitely worthy of discussion.

In the absence of a written document, the family must make decisions about treatment measures. Family members may disagree on this issue and tempers often flare in the midst of powerful emotions. If your loved one is incapable of communicating their wishes, you must make decisions on their behalf.

Family members should gather in advance to frankly discuss how this will be managed. Meet with the physician and have a checklist of questions. You may not be successful in gaining agreement from everyone. In that case the decisions must be made by the person who is legally able to do so, such as a spouse or parent.

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