Advance Directives

GENERAL INFORMATION:

What are advance directives? You have a right to help make decisions about your own health and well-being. Advance directives are spoken or written plans and information about the medical care you prefer. They are also called advance care plans. These plans are made ahead of time in case you lose your ability to make decisions for yourself. With these plans, you can make decisions when you are able to think clearly about your wishes, use good judgment, and talk to others. Advance directives can apply to any medical decision, such as the treatments you want, and if you want to donate organs. There are many types of advance directives, and each state has rules about how to use them.

What are the types of advance directives?

• Living will: This is a written record of the care you choose for yourself. It describes what types of treatment you want. It also states what treatments you do not want, which to limit, and which to stop at a certain time. This includes surgery, medicine, intravenous (IV) fluid, and tube feedings.
  
  
• Durable power of attorney for healthcare: This is a written record that states who you choose as your healthcare proxy or agent. This person makes health care choices for you when you are unable to make them for yourself. The proxy is usually a family member or a friend, and may be one or more persons.
  
  
• Do not resuscitate order: This is also called DNR, do not attempt resuscitation (DNAR), or no code order. A DNR order is used in case your heart stops beating or you stop breathing. It is a request not to have certain forms of treatment such as cardiopulmonary resuscitation (CPR). This order may be included in other advance care plans.
  
  
• Medical directive: This is a written advance care plan. It covers the care that you want to receive in different medical situations, such as being in a coma. It also covers care if you were to be near death, or in a state where you cannot think or respond (vegetative state). End-stage cancer and dementia (being unable to make decisions) are other conditions where this plan applies. You are asked to choose treatments for each of these conditions. Treatment options include pain medicine, surgery, blood transfusions, dialysis, IV or tube feedings, and a ventilator (breathing machine).
  
  
• Values history: This document has questions about your values. It reflects your own views, beliefs, and how you feel and think about life. By knowing this information, others can better choose the health care decisions that you would choose. This advance care plan includes your choices of medical care and healthcare proxy.
  
  
• Combination document: This advance care plan can include two or more types of plans, such as a living will and values history.

• When writing your advance care plan, make sure you fully understand treatments or care you may receive. The care that you do want is as important as the care that you do not want. Think about the benefits and problems that each of your decisions could cause for you and your family. Look at brochures, videos, or other sources to help you know more about advance care plans. Talk to caregivers if you have concerns or questions before you write down your wishes. You may also talk with a clergy or social worker. Check your state laws to make sure that what you put in your care plan is legal.
  
  
• Sign and date your care plan when you have finished. You may need two witnesses when you do this, who will also need to sign the plan. Witnesses cannot be your doctor or his staff, your spouse, heirs or beneficiaries, people you owe money to, or your chosen healthcare proxy. Talk to your family, healthcare proxy, and caregivers about your care plan. This will help everyone understand your wishes. Give each person a copy of your plan, and keep one for yourself. Place it in an easy to get to place at home. Do not place it in a hidden or locked box or safe.
  
  
• You can revise your advance care plan at any time, as long as you are able to make decisions. Review your plan every year, and when there are changes in your life, or your health. Each state has different rules about these plans. You may need to revise your plan if your wishes do not agree with the state rules. When you make changes, always let your family, healthcare proxy, and caregivers know. Give each one of them a new copy of your plan.

• American Academy of Family Physicians
  PO Box 11210
  Shawnee Mission, KS 66207-1210
  Phone: 1-913-906-6000
  Web Address: http://www.aafp.org
  

• National Hospice & Palliative Care Organization (NHPCO)
  1700 Diagonal Road, Ste 625
  Alexandria, VA 22314
  Phone: 1-703-837-1500
  Phone: 1-800-658-8898
  Web Address: http://www.nho.org