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Advance Directives, Living Wills, and Powers of Attorney
Advance Directives tell family members, friends and doctors what medical care you would want or not want if you cannot communicate because of temporary or permanent illness or injury. Types of directives include Living Wills, Health Care (Medical) Power of Attorney, Mental Health Care Power of Attorney and Prehospital Medical Care Directive (DNR or orange form). Advance Directives take effect only if you are not able to communicate your wishes or lack the capacity to make healthcare decisions.
A living will is a written statement about what treatment you would want if you are seriously ill, in a persistent vegetative state or irreversible coma. It provides guidance about your general philosophy—ranging from “I do not want any life-sustaining treatment beyond comfort care” to “I want my life to be prolonged as long as possible.” You also specify whether you want cardiopulmonary resuscitation, artificially administered food and fluids or to be taken to the hospital. If tube feedings have already been started, a living will doesn’t allow health-care providers to stop them—only the Health Care (Medical) Power of Attorney or legal guardian has the authority to do that.
(Click here for a free living will download.)
A Health Care (Medical) Power of Attorney appoints someone to make medical decisions for you if you can’t make them yourself. That includes a decision about whether to continue artificially administered food and fluids. You can name an alternate Health Care Power of Attorney if the first one cannot serve. You can name more than one person as MPOA, but everyone would have to agree on decisions.
A Mental Health Care Power of Attorney appoints someone to make mental health care decisions for you if you become mentally incapacitated.
Emergency Medical Service personnel (paramedics) are required to resuscitate, stabilize and take people to the hospital. If you do not want CPR or other forms of resuscitation and do not want to be taken to the hospital, you must complete a Pre-Hospital Directive, also known as “Do Not Resuscitate” or orange form because it is printed on orange paper.
Many states give decision-making power to “surrogates,” primarily in order of kinship. Without a living will, the surrogate won’t know your wishes. A surrogate also cannot disconnect a feeding tube. Only a health care (medical) power of attorney or a guardian appointed by a judge can make that decision.
You can write your own advance directives or use any form as long as your signature is properly witnessed. The witness to your signature cannot be related to you by marriage or adoption or benefit from your estate. In some states, the form does not have to be notarized. However, if you travel you may wish to have the forms notarized because this is a requirement in some states. Only the Prehospital Medical Care Directive—the DNR or orange form—must be signed by a licensed health care provider.
Advance Directives are effective as soon as they are signed and witnessed. They do not have an expiration date. If you want to update your advance directives, make out new ones and destroy the old ones. The directive with the most recent date is the legal one.
Distribute copies to your relatives, friends and doctors who may be involved in your health care. Talk to them about your intentions and wishes. Answer their questions. Talking enhances understanding. If you wish, register your Advance Directives with the Secretary of State’s Office (depending on your state). This is not a requirement. But registration makes the documents accessible at all times via computer to people who have a password to view them.