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Advance Directives: Ensuring Your End-of-Life Wishes Are Respected

Alan Lucks | MD

Medically reviewed by Alan Lucks | MD, Alan Lucks MDPC Private Practice - New York on February 26th, 2024.

Key Takeaways

  • Adults over 18 should complete both a living will (specifying treatment preferences like DNR orders) and designate a healthcare proxy who can make decisions when they're incapacitated.
  • State-specific forms are required—California's POLST differs significantly from Texas advance directives, and documents must include proper witnessing (usually 2 witnesses) or notarization to be legally valid.
  • Critical life changes like marriage, divorce, new diagnoses, or family deaths should trigger document updates, as outdated directives naming deceased proxies become ineffective during emergencies.
  • Copies must be distributed to your primary care physician, local hospital, designated healthcare proxy, and kept easily accessible at home—many people complete forms but fail at this crucial distribution step.
  • HIPAA authorization should be included to allow your healthcare proxy to access medical records and communicate with doctors, as standard advance directives don't automatically grant this access.

It's not easy to think about death and dying, but it's crucial to make your wishes known in case you're unable to speak for yourself. Advance directives are legal documents that outline your preferences for end-of-life care, ensuring that your loved ones and healthcare providers know what you want.

What Are Advance Directives?

Advance directives are written instructions that specify your wishes for medical care if you become incapacitated and cannot make decisions for yourself. There are two main types of advance directives:

Living Will: A document that outlines your preferences for life-sustaining treatments, such as cardiac resuscitation, tube feeding, and mechanical respiration.

Medical Power of Attorney: A document that names a trusted person to make healthcare decisions on your behalf if you are unable to do so. It's important to note that while you are alive and medically competent to make your own decisions, your medical power of attorney does NOT have any authority to consent on your behalf.

Advance Directives: Ensuring Your End-of-Life Wishes Are Respected

Why Are Advance Directives Important?

Advance directives are essential for anyone, regardless of age or health status. Unexpected accidents or illnesses can happen to anyone, leaving you unable to communicate your wishes. By having advance directives in place, you can:

  • Ensure your healthcare preferences are respected

  • Reduce the burden on your loved ones to make difficult decisions

  • Prevent unnecessary suffering and unwanted medical interventions

Creating a Living Will

When creating a living will, consider the following questions:

  • Do you want all available pain relief options, even if they may unintentionally hasten your death?

  • Which life-sustaining treatments do you want or not want, and for how long should they be continued if your condition doesn't improve?

  • What are your preferences for artificial life support if you are brain dead?

  • What are your wishes regarding organ donation and the disposition of your body after death?

Each state has its own advance directive form, which you can download and complete without an attorney. Be sure to add any additional information about your wishes if the form doesn't cover everything you're concerned about.

Choosing a Medical Power of Attorney

When selecting a medical power of attorney, look for someone who:

  • Is not intimidated by medical professionals and is willing to ask challenging questions

  • Can put aside their own feelings to ensure your wishes are carried out

  • Understands your wishes about medical options and end-of-life care

Consider choosing an alternate power of attorney in case your first choice is unable to fulfill the role. Discuss possible scenarios and your general wishes with your chosen power of attorney to ensure they understand your desires.

Legalizing Your Advance Directives

To make your advance directives legally binding, you must put them in writing using your state's specific forms. These forms generally require witnesses and/or notarization, so carefully follow your state's requirements. Once completed, provide copies to your doctor, hospital, hospice or palliative care team, important family members, and attorney.

By taking the time to create advance directives, you can ensure that your end-of-life wishes are respected and reduce the burden on your loved ones during a difficult time.

Additional Resources:

The Bottom Line

Properly executed advance directives require state-specific forms, legal witnessing, and strategic distribution to healthcare providers and family members to ensure they're available during medical emergencies. Regular updates every 5-10 years or after major life changes keep these documents current and legally effective. If you need guidance on creating advance directives or have questions about healthcare planning requirements in your state, Doctronic can provide quick answers.

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