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What is an advance directive?

An advance directive (sometimes called a special directive) is a document that tells your healthcare provider and family what kind of medical care you would want (or wouldn't want) if you become ill and can't speak for yourself. An advance directive takes effect only if you can't express your wishes; for example, if you're in a coma.


In a living will, one type of advance directive, you tell healthcare providers what kind of treatments you'd want (or would refuse to have) if you were dying and unable to speak for yourself, or if you become permanently unconscious. For example, you may state that you wouldn't want to be kept alive on a breathing machine if you're unconscious with no hope of recovery.


A living will won't prevent you from getting medical care if you're sick or injured. It simply informs healthcare providers about what kind of care you'd want if you were dying and couldn't speak for yourself. You can cancel or change these instructions at any time.


A durable power of attorney for healthcare, also called a healthcare proxy or surrogate, is another type of advance directive. You use it to name someone you trust to make healthcare decisions for you if you can't speak for yourself. Like a living will, it takes effect only if you can't make medical decisions for yourself. The person you name must be at least age 18 and usually can't be your doctor or other healthcare provider.


Which type of advance directive do I need?

The American Bar Association (ABA) recommends that patients have both a living will and a durable power of attorney for healthcare. Although a living will is more detailed, it may not cover a medical situation you experience in the future. In that case, having a durable power of attorney for healthcare lets a trusted relative or friend make decisions about a situation or treatment not covered in your living will.


Living wills and durable powers of attorney for healthcare are for everyone, not just older adults. Sudden illness or an accident can happen to anyone.


How do I prepare an advance directive?

Prepare any advance directive when you're feeling well. Discuss your wishes with your family and with the one person you name to make decisions for you, so he or she will know what you'd want if you become seriously ill and can no longer speak for yourself.


Your healthcare provider or local hospital can provide you with forms to fill out. If you're admitted to a hospital, you'll be asked if you have an advance directive; if you don't, the hospital can give you forms if you want them. For forms and an ABA toolkit, see Selected websites at the end of this article.


You don't need a lawyer to write your advance directive, although you may want to ask one to help you. Follow legal requirements (as outlined on the form) for preparing valid documents and make sure you put the date on all your documents. Usually you'll need two people to witness your signature; some states also require you to have your signature notarized.


Make several copies of your advance directive. Keep one for yourself and give others to your healthcare providers, lawyer, family members, and friends. Take copies of these documents if you're being admitted to a hospital or long-term-care facility. If your wishes change, write new documents and destroy the old ones.




AARP: Preparing an Advance Directive: http://www.aarp.org/relationships/caregiving/info-01-2011/caregiver_map.html


American Bar Association Consumer's Toolkit for Health Care Advance Planning: http://www.abanet.org/aging/toolkit/home.html


U.S. Living Will Registry Advance Directive Forms: http://uslwr.com/formslist.shtm