Advance directives are legal instructions designed to acknowledge your preferences of medical care when you are no longer in a position to make decisions for yourself or it would hurt you to do so.
These directives allow doctors and caregivers to make the right choice for you if you are in a coma, in an advanced stage of dementia, or when death is almost inevitable and you cannot make your own decisions.
Believing you are too young for an advanced directive is where we get it wrong most of the time. Especially if you are an adult (20 or 21 years and above). Anyone can find themselves in these states. Hence, it is not just crucial but wise to prepare these legal documents.
Thanks to this planning, you can be assured you get your preferred form of medical treatment, eliminate all forms of extraneous suffering and unburden doctors or caregivers of the pressure of decision making.
There are two major types of advance directives:
- The Living Will
- The Durable Power of Attorney for Healthcare (the medical power of attorney).
In other words, an advanced directive form contains the Living Will, Durable Power of Attorney and a series of secondary documents addressing issues like personal hygiene, palliative care, religious considerations, and other factors that makes the directive complete.
In this article, you will get to understand the kind of decisions an advance directive entails, questions you can ask yourself in preparation for the future, and more. Let’s begin!
What is Medical Power of Attorney?
A medical power of attorney (medical POA or health POA) is a legal document that contains the name of your preferred agent and gives them the authority to make tough medical decisions for you. A medical POA may be referred to as a durable power of an attorney or power of an attorney (which is the general way of putting it).
The agent can only use the medical power of attorney if your doctor says you are not in the best position to make decisions.
Hence, such an individual must:
- Be someone you trust with your life
- Be a qualified healthcare provider by your state’s standards.
- Not be your doctor or belong in your medical team
- Be strong and be able to stick to your priority as stated in the document irrespective of what ensues
- Be someone willing to discuss medical care and life-threatening conditions with you
While they are commonly known as a healthcare agent or proxy.
They may also be called a:
- Healthcare surrogate
- Healthcare representative
- Healthcare attorney-in-fact
- Patient advocate
PS: Some states combine both “power of attorney” and “living will” into a single advanced directive.
What is Living Will?
After choosing a proxy (thanks to the medical power of attorney), you must state your preferred choice of medical care in a form. This written document is known as a Living Will. Please note that this document can only be acted upon when you lose the ability of decision-making.
A Living Will is a legal document that dictates what you want and does not want in terms of near-death medical treatment.
Before writing a living will, you must consider when and how long you will be needing the following:
- Mechanical ventilation: If you are unable to breathe and for how long.
- Cardiopulmonary resuscitation: Determine when you want your heart function restored thanks to CPR or other resuscitating devices.
- Dialysis: A process that eliminates waste from your blood and manages fluid level once your kidney no longer functions.
- Tube feeding: Provides your body with needed nutrients and fluid intravenously via a tube attached to the stomach.
- Comfort care: These are measures that ensure your comfort while adhering to your advance directive priorities. Events such as the use of pain medication, avoiding invasive tests are considered comfort care.
- Organ and tissue donation: It involves transplantation and may involve the donor’s life being kept alive until the process is over. I’ll talk more about this in the course of the article.
- Other factors to consider include your values, the importance of being independent, what will make your existence worthless, extending your treatment if there is hope for a possible cure, how you want your body disposed of after death, use of medication, just to name a few.
PS: Forms for advance directives differ depending on your state. They may be notarized or require a witness’ signature.
Advance Directive vs Other Forms
|Form||Health Care Agent||Decide Treatments||Prohibit CPR|
|Medical Power of Attorney||Yes||No||No|
|Do Not Resuscitate (DNR)||No||No||Yes|
How to Create an Advance Directive?
It is a known fact that each state present you with different forms to be filled and depending on your location, each state-specific forms should be present on various organizations such as the America Bar Association, the National Hospice and Palliative Care Organization, and more. Hence, you do not necessarily need an attorney to prepare one for you.
The best way to go about these forms is to review them with your doctor to be sure everything is done correctly. Upon completion, you are expected to:
- Keep the original document in a safe and easily accessible space
- Provide your healthcare provider with a copy
- Give another copy to your healthcare agent or his equivalent
- Own a record of people with these copies
- Talk to your family about these steps you have taken, your priorities, to foster unison when the time comes
- Always go along with a wallet-size card that has all the information about your advance directives and people with access to it. You can also have a different copy for traveling.
Free Advance Directive Forms
Just like there is a will to share your acquisition peacefully when you pass away, advance directives render this service to your health. Making known your preferences and keeping your family whole even after you are dead or almost. Because no one knows tomorrow, we would advise you to start planning towards getting one anytime from now.
Forms by State
Signing Requirements by States
Each state has a different signing requirements and administered by the State the principal resides. After the signing, the form can be used immediately.
|Alabama||Two (2) witnesses||§ 22-8A-4|
|Alaska||Two (2) witnesses or a notary public||AS 13.52|
|Arizona||One (1) witness or a notary public||§ 36-3224, § 36-3262|
|Arkansas||Two (2) witnesses or a notary public||§ 20-6-103, § 20-17-202|
|California||Two (2) witnesses or a notary public||PROB § 4701|
|Colorado||Two (2) witnesses||§ 15-14-506, § 15-18-104|
|Connecticut||Two (2) witnesses||Sec. 19a-575a, Sec. 19a-575|
|Delaware||Two (2) witnesses||§ 2503(b)|
|Florida||Two (2) witnesses||§ 765.202(1), § 765.302(1)|
|Georgia||Two (2) witnesses||§ 31-32-5(c)(1)|
|Hawaii||Two (2) witnesses or a notary public||§ 327E-3(b)|
|Idaho||Principal only||§ 39-4510|
|Illinois||Two (2) witnesses||755 ILCS 35/3(b)|
|Indiana||Two (2) witnesses||§ 16-36-4-11|
|Iowa||Two (2) witnesses and a notary public||§ 144B.3(b)|
|Kansas||Two (2) witnesses and a notary public||§ 58-632, § 65-28,103|
|Kentucky||Two (2) witnesses or a notary public||§ 311.625(2)|
|Louisiana||Two (2) witnesses||RS 28:224, RS 40:1151.4|
|Maine||Two (2) witnesses||§ 5-803(2)|
|Maryland||Two (2) witnesses||§ 5-602(c)|
|Massachusetts||Two (2) witnesses||§ 201D-2|
|Michigan||Two (2) witnesses or a notary public||§ 700.5501(b)|
|Minnesota||Two (2) witnesses or a notary public||§ 145C.03|
|Mississippi||Two (2) witnesses or a notary public||§ 41-41-209|
|Missouri||Two (2) witnesses and a notary public||§ 459.015, § 404.835|
|Montana||Two (2) witnesses and a notary public||§ 53-21-1304(2)(d)|
|Nebraska||Two (2) witnesses or a notary public||§ 30-3404, § 20-404|
|Nevada||Two (2) witnesses||NRS 162A.790, NRS 449A.439|
|New Hampshire||Two (2) witnesses or a notary public||§ 137-J:14|
|New Jersey||Two (2) witnesses||§ 26:2H-56|
|New Mexico||Principal only||§ 24-7A-2(B)|
|New York||Two (2) witnesses||PBH § 2981|
|North Carolina||Two (2) witnesses and a notary public||§ 90-321|
|North Dakota||Two (2) witnesses or a notary public||§ 23-06.5-05|
|Ohio||Two (2) witnesses or a notary public||§ 2133.02(A)(1)|
|Oklahoma||Two (2) witnesses||§ 63-3101.4|
|Oregon||Two (2) witnesses or a notary public||ORS 127.515(2)(b)|
|Pennsylvania||Two (2) witnesses||§ 5442|
|Rhode Island||Two (2) witnesses||§ 23-4.11-3, § 23-4.10-2|
|South Carolina||Two (2) witnesses and a notary public||§ 62-5-504, 44-77-40|
|South Dakota||Two (2) witnesses and a notary public||§ 59-7-2.1, § 34-12D-2|
|Tennessee||Two (2) witnesses or a notary public||§ 68-11-1803(b)|
|Texas||Two (2) witnesses or a notary public||§ 166.154, § 166.003|
|Utah||One (1) witness||§ 75-2a-107(c)|
|Vermont||Two (2) witnesses||18 V.S.A. § 9703|
|Virginia||Two (2) witnesses||§ 54.1-2983|
|Washington||Two (2) witnesses or a notary public||RCW 11.125.050, RCW 70.122.030|
|West Virginia||Two (2) witnesses and a notary public||§ 16-30-4|
|Wisconsin||Two (2) witnesses||§ 244.05, § 154.03(1)|
|Wyoming||Two (2) witnesses and a notary public||§ 35-22-403(b)|
Other Advance Care Planning Documents
Aside from the medical power of attorney and a living will, other advance care planning documents include:
- DNR (do not resuscitate) order
- DNI (do not intubate) order
These documents are independent of a living will and are significant if you are constantly moved from one hospital to another. To establish any of these orders, all you have to do is tell your doctor your preference and he or she will put it into writing and include it in your medical record.
DNR order: A DNR order Instructs medical personnel to forgo any attempt to restore your heart’s function using CPR or any other life support device if it eventually stops beating. This document may also be referred to as the DNAR (do not attempt resuscitation) or AND (allow natural death). A DNR order consolidates whatever is written in your living will to eradicate any form of confusion.
A DNI: instructs medical staff not to place you on any form of breathing mechanisms.
A non-hospital DNR: instructs medical emergency personnel about your priorities in terms of heartbeat restoration when you are outside a healthcare facility.
Organ and Tissue Donation
This process gives room for the donation of an organ or tissue from a healthy individual who has passed away to patients in need of it. Organs such as lungs, kidneys, liver, etc are common to this field. No age is exempted from this process. All you need is a donation card and your request will be added to your planning documents.
PS: Some states allow for the inclusion of this priority on your drivers’ license. It can also fit in wallets.
When you die, family members may be asked about donating some healthy organs in your body. Your loved ones or proxy might reveal your thoughts about organ donation. If you are cool with the idea of donating any of your organs to assist others, you might need to specify that the need (for donation) transcends your request for DNR. Especially in cases where your heart needs to be kept alive via a support device.
Brain donation unlike other types of donation is used ONLY for scientific researches. Through these studies, scientists discover how diseases impact the brain and the best way to manage them better.