If you are smartly preparing ahead of time for important and inevitable decisions in your older years, you will likely be involved in creating an advance directive. Advance directives are critical, medical-related components of financial and estate planning. However, confusion sometimes arises around the definition of this important legal document and its purpose.
Simply stated, advance medical directives explain to others what medical treatment you desire or would want in specific circumstances or designate someone to make medical decisions on your behalf if you are unable. Advance directives center on principles of a person’s right to die, as well as death with dignity; they become a way of making your voice heard if you can no longer communicate. Without a medical directive, health care providers are required to prolong your life as long as possible via specialized machines, most of which have the ability to sustain a person’s life for days, weeks, or even years. To that end, anyone who wishes to have direction over their future medical care, not just elderly people, should create an advance directive.
At first glance, an advance directive appears to be the same as a living will and in fact they are closely related. A living will is a type of advance directive, along with powers of attorney, do not resuscitate orders, and organ donor forms. Every U.S. state allows a particular type of advance directive and in some cases all three. Similarly, a person might require all three in order to ensure specific medical treatment is completed. It is always best to verify with the state in which you live for the latest document requirements.
One common misperception with advance directives is that they mean “do not treat.” This is incorrect unless of course a patient specifies as such in the directive. There is also no difference between withholding lifesaving treatment and withdrawing life-support treatment. This is critical in cases when a directive is not present or cannot be found and a patient is resuscitated despite their wishes and subsequently put on life support.
In all situations, creation and execution of an advance directive can be a complex and uncomfortable task and this life step should always be discussed with loved ones. For now, let’s look closer at these common advance directive types.
What are common types of advance directives?
In touch and go situations where you are unable to make decisions related to your medical care, a living will in effect “stands in” for you in regard to approving or declining specific types of medical care, whether it be intensive surgery or even if you die as a result of treatment. Living wills are typically only used in times of terminal illness as a means to decline medical treatment when that treatment’s only purpose is to postpone death, or when a patient remains trapped in a persistent vegetative state.
Of course, it is impossible to predict future medical scenarios involving disease over a lifetime and many people have a change of heart with their living wills. While a person is still capable of making sound decisions, it is perfectly acceptable to modify a living will to reflect any changes.
Keep in mind that living wills are not the same as a last will and testament.
Durable power of attorney with health care proxy
A health care power of attorney allows you to designate a specific person as representative to make important medical decisions for you, in the event you become temporarily or permanently unable to make those decisions. Within this document, you can declare in great detail the extent of power the representative will have. Most people choose a family member for this role, or perhaps a relative or close friend. In all cases, it is important to ensure the appointed representative fully understands your wishes and retains a written copy of a living will or power of attorney.
Do not resuscitate order
This straightforward document is an order telling medical staff not to perform CPR in the event a patient falls into cardiac arrest. DNR orders appear in one of two types, one applying to a hospitalized patient and the other when a patient is outside of a hospital.
Life-prolonging treatments often come into play with DNR orders. These treatments are procedures that are not expected to cure a patient’s terminal condition and instead are used to sustain life. Examples include kidney dialysis, mechanical ventilators, and CPR.
Organ donation forms
Another medical order typically found in an advance directive is an organ donation form, which specifies your wishes to donate your organs after your death. Some states do not include an organ donor section in advance directives and if this is the case, you can include instructions within the directive itself or in a separate letter of intent. Again, it is wise to verify details with your particular state.
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