Every competent adult has, in most cases, the freedom to accept or refuse medical treatment. When you are well, you can talk with your physician and family and make your wishes known. However, severe illness or an accident could result in an inability to communicate or to make choices. During that time, important decisions about your medical care may have to be made. Without any written instructions from you, your family and physicians would have to guess what treatment you would want. In some cases, they may be forced to proceed with treatments they know you would not desire simply because your preference was not expressed in writing. You can help your family and physicians by telling them, in advance, what you would want done in certain situations. This planning ahead for future healthcare decisions is known as an “ADVANCE DIRECTIVE.” Your DIRECTIVE goes into effect only if you become unable to make choices or express your wishes. You can change it at any time up until that point.
You may also choose a person to act as your HEALTH CARE SURROGATE to make decisions for you if you are unable to make them for yourself. Your HEALTH CARE SURROGATE is obligated to make the choices he or she believes you would make if you were able. You are encouraged to complete both the DIRECTIVE and the appointment of a surrogate since not every possible situation is addressed in the DIRECTIVE. Your DIRECTIVE can assist your surrogate in determining what your wishes would be.
Before you fill out the ADVANCE DIRECTIVE – LIVING WILL form, you may want to talk to your family, friends, physician, lawyer, or spiritual advisor. If you choose to designate a HEALTH CARE SURROGATE, since that person may someday be called upon to make decisions on your behalf, you may want to discuss your thoughts with your surrogate.
When you make your personal choices in the DIRECTIVE, you may want to consider one question. Is there a condition or set of circumstances which could exist in which you would refuse efforts to prolong your life? The DIRECTIVE describes three situations and allows you to indicate which treatments you would want or would not want if your physician recommended them. If a situation you are particularly concerned about is not included, you can make additional comments in the section provided.
After you complete it, give a copy to your regular physician, your health care surrogate and to a trusted family member or friend.
Frequently Asked Questions about Advanced Directives
1. What is an Advance Directive?
It is any written instructions you give relating to the provision of health care in the event you become unable to make your own decisions. Examples of advance directives include: Living Wills, Durable Power of Attorney, and Appointment of a Health Care Surrogate. Using a directive you give specific instructions about your health care in certain situations, or designate a person to act on your behalf in decision making, or a combination of the two.
2. Is a Living Will the Same Thing as an Advance Directive?
A Living Will is one kind of advance directive; however, at the present time, in some state the standard Living Will only pertains to situations involving a terminal illness. Many conditions and situations may arise which do not involve a terminal illness. The Advance Directive – Living Will is an expanded form addressing terminal illnesses and other conditions.
3. What is a Persistent Vegetative State?
The term refers to a condition caused by a brain injury. The victim is unable to respond to his or her surroundings and is not aware of anything, even though the eyes may be open periodically. It is similar to a coma in that the person is unresponsive, but it is a permanent condition. A head injury, stroke or other events may result in this condition and a person may be kept alive indefinitely in this condition by artificial means.
4. Are Advance Directives Just for “Senior Citizens”?
No. A severe illness or serious accident can happen to a person at any age. If you have strong feelings about what choices you would want in such a situation, regardless of your age, you are encouraged to consider an advance directive.
5. May I Change My Advance Directive?
Yes, you may do so at any time. If you do make changes to any advance directive, be sure to destroy all of the outdated copies and provide copies of the updated version to the appropriate people.
6. Will My Advance Directive Be Honored in an Emergency?
Usually it is not possible to determine the chances of survival in an emergency situation or to determine the outlook for recovery. After the initial emergency has passed and the prognosis for recovery is known, your advance directive will come into play if you are not able to express your wishes.
7. Is It Difficult to Stop a Treatment Once It Has Been Started?
No, not if you have an advance directive and your instructions are clear. Particularly in conditions with a sudden onset, it may take days or even weeks before prognosis is known to a reasonable degree of certainty. During the time before the outlook is known, it is appropriate to use any treatments which might be beneficial. When the prognosis is established, if your instructions indicate you would not want continued treatment under the circumstances, treatment can be stopped.
8. What is a Health Care Surrogate?
A health care surrogate is a person you choose to make health care decisions for you if you are not able to do so for yourself. Your surrogate should be someone who knows your wishes and who will make decisions based on what he/she believes you would want, not based on his or her own preferences. You are encouraged to appoint a health care surrogate even if you have made other written expressions of your wishes, since it is difficult to address every situation in a directive.
9. May I Request that I Not Be Given Food and Water Artificially?
Yes, It is believed your right to make choices includes the ability to choose not to be given food and water artificially, even if withholding this treatment shortens your life.
10. Are There Any Limitations on Carrying Out Instructions in My Directive if I Am Pregnant?
Yes. Most likely any instructions which would result in withholding or withdrawing life-prolonging treatments would not be honored during the time you are pregnant.
11. What About My Religious Beliefs?
Some choices you may make in filling out an advance directive may not be in keeping with the teachings of your religion. If this is a concern to you, discuss the matter with your minister, priest, rabbi, or other spiritual mentor.
12. Do I Need a Lawyer or a Notary to Complete an Advance Directive?
In most cases, no; the document need only be signed in the presence of two witnesses. One of the witnesses must be someone who is not your spouse, blood relative, heir, or person responsible for paying your medical bills. However, if you have any questions concerning the legal effect of these documents or any other aspect of this matter, you should contact your attorney.
13. After I Complete an Advance Directive, What Do I Do With It?
Give copies to someone who would know if you became seriously ill. You may also want to consider giving a copy to your physician, minister, family members or close friends. Discuss with them the details of your directive and ask that they keep a copy to make available if it is ever needed. Of course you should give a copy to your health care surrogate, if you appoint one.