Advance care directives

  • Alternative Names
    • Living will; Power of attorney; DNR - advance directive; Do not resuscitate - advance directive; Do-not-resuscitate - advance directive; Durable power of attorney - advance care directive; POA - advance care directive; Health care agent - advance care directive; Health care proxy - advance care directive; End-of-life-advance care directive; Life-support - advance care directive

  • Why Write an Advance Directive?
    • When you are very ill or injured, you may not be able to make health care choices for yourself. If you are unable to speak for yourself, your health care providers may be unclear as to what type of care you would prefer. And your family members may be uncertain or disagree about the type of medical care you should receive. An advance care directive is a legal document that tells your providers what care you agree to in advance of this type of situation. With this document, you can tell your providers what medical treatment you do not want to have and what treatment you want no matter how ill you are.

      Writing an advance care directive may be hard. You need to:

      • Know and understand your treatment options.
      • Decide future treatment options you may want.
      • Discuss your choices with your family.
  • Living Wills
    • A living will explains the care you do or do not want. In it, you can state your wishes about receiving:

      • CPR (if your breathing stops or your heart stops beating)
      • Feedings through a tube into a vein (IV) or into your stomach
      • Extended care on a breathing machine
      • Tests, medicines, or surgeries
      • Blood transfusions

      Each state has laws about living wills. You can find out about the laws in your state from your providers, the state law organization, and most hospitals.

      You should also know that:

      • A living will is not the same as a last will and testament after a person's death.
      • You are not able to name someone to make health care decisions for you in a living will.
  • Other Types of Advance Directives
    • Other types of advance directives include:

      • Special health care power of attorney is a legal document that allows you to name someone else (a health care agent or proxy) to make health care decisions for you when you cannot. It does not give power to anyone to make legal or financial decisions for you.
      • A do-not-resuscitate order (DNR)is a document that tells health care providers not to do CPR if your breathing stops or your heart stops beating. Your provider talks to you, the proxy, or family about this choice. The provider writes the order on your medical chart.
      • Fill out an organ donation card and carry it in your wallet. Keep a second card with your important papers. You can find out about organ donation from your provider. You can also have this choice listed on your driver's license.
      • Verbal instructions are your choices about care that you tell providers or family members. Verbal wishes usually replace those you made previously in writing.
  • Additional Information
    • Write your living will or health care power of attorney according to your state's laws.

      • Give copies to your family members, providers, and health care agent.
      • Carry a copy with you in your wallet or the glove compartment of your car.
      • Take a copy with you if you are in a hospital. Tell all medical staff involved in your care about these documents.

      You can change your decisions at any time. Be sure to tell everyone involved, family members, proxies, and providers, if you make changes to your advance directive or a living will is changed. Copy, save, and share the new documents with them.

  • References
    • Fabiny A, Sabatino C. Living Wills: A Guide to Advance Directives, the Health Care Power of Attorney, and Other Key Documents. Cambridge, MA: Harvard Health Publications; 2013.

      Rakel RE, Trinh TH. Care of the dying patient. In: Rakel RE, Rakel DP, eds. Textbook of Family Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 5.

      Zorowitz RA. Ethics. In: Ham RJ Jr, Sloane PD, Warshaw GA, Potter JF, Flaherty E, eds. Ham's Primary Care Geriatrics: A Case-Based Approach. 6th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 7.