Advance directives
Summary
Advance directives are legal documents that say what kind of medical treatment a person wishes to receive in an emergency or at end-of-life, and gives their health-care providers the right to act on those wishes. This article briefly describes the most common kinds of advance directives. It then explains why advance directives are important and when a person should get them drawn up.
What are advance directives?
Advance directives are documents that state a person’s health-care wishes and give their health-care providers the legal right to give or withhold medical treatment according to those wishes when the person can no longer make decisions for themselves. A common example is the person deciding they don’t want to be kept alive if they can no longer breathe on their own.
In many states, but not all of them, the term “advance directive” also includes a document called durable medical power of attorney (MPOA). Even if you live in a state that doesn’t count MPOA as an advance directive, the document is still available.
In some states, all the directives can go into one legal document. In other states, different directives go into different documents.
What are the most common advance directives?
The most common advance directives are:
- Durable medical power of attorney. This document is also called “durable power of attorney for health care.” It gives an individual the power to make medical decisions for their loved one when the loved one is no longer able to do so for themselves.
- A living will. This document tells caregivers and health-care workers what medical treatments the person does and does not want. For example, they may say that they don’t want to be given radiation treatment if they have terminal cancer, or that they don’t want to be put on a feeding tube if they can no longer eat.
- A Do Not Resuscitate (DNR) order. This order tells the doctor that the person should not be given CPR if they stop breathing or their heart stops beating. Unlike with a living will, medical workers outside a hospital, such as emergency medics, are legally allowed to follow the DNR order. A person with a DNR order will often be given a necklace or bracelet telling medical workers not to try to resuscitate them.
- A Do Not Intubate (DNI) order. This order tells doctors or emergency medics not to put a breathing tube into a person’s airway if they have stopped breathing on their own or can only breathe when put on a ventilator.
What are some less common advance directives?
Other less commonly used advance directives include:
- Tissue and organ donation forms. These allow a person’s tissue and organs to be given to people who need them.
- Brain donation form. This allows a person’s brain to be donated for scientific research.
- Portable medical order (POLST). This document gives end-of-life instructions that are more detailed and specific to the person’s medical condition. It is used in addition to a living will.
Why are advance directives important?
Advance directives are important because they give doctors and other health-care workers the legal right to follow their patients’ wishes by withholding certain types of treatment.
For example, if a person has not created a DNR order, doctors must give them CPR when their heart stops beating, even if they know the person does not wish it. They would be breaking the law if they failed to give CPR. With this advance directive, however, doctors are allowed to respect the person’s wishes and not give CPR.
The durable medical power of attorney is important because it means that a person who knows the individual well—usually a family member or close friend—can make sure that their loved one gets medical treatment and end-of-life care according to their wishes and values.
When should a person create advance directives?
A person should create advance directives and do other health-care planning as early as possible. Even younger people can get into an accident that leaves them needing long-term medical care.
It is important to remember that any advance directive, including durable medical power of attorney, only takes effect when the person can no longer make decisions for themselves. As long as the person can communicate and is mentally competent, they will always have the right to make decisions about their own medical treatment. That includes accepting or refusing specific medical treatments.
Doctors must, by law, follow the person’s wishes as long as that person can decide for themselves. This is the case even if the person has created an advance directive that says the opposite.
A person can also withdraw or change an advance directive at any time.
Related information
Do Not Resuscitate and Do Not Intubate orders
Living wills
Medical power of attorney
Overview of legal documents
Portable medical orders (POLST)
