The Advance Directive for Health Care

An advance directive for health care is a legal document in which you state the medical treatment you want to receive at some time in the future if you are not able to speak or make sound decisions for yourself. Other names for it are advance directive, health care directive and medical directive. It consists of three parts: the living will, power of attorney and do not resuscitate form (DNR).

The living will is the part of the set of documents in which you make known to your doctor and family members the kind of care you would like to receive as you near the end of life and you can no longer speak for yourself. It is prepared in advance of circumstances requiring its use and does not override your expressed desires. Therefore, your consciously stated desires will always prevail over what's in the document if the two don't agree.

A living will might specify the withholding and/or withdrawing of treatment. It can be general or specific. A general one usually includes wording that directs the withholding or termination of any treatment, other than that for comfort, if you have a terminal illness. More specific instructions apply to the withholding or withdrawing of specific forms of treatment. They might include things such as artificial feeding, intravenous fluids, or intravenous antibiotics. 

A medical power of attorney is that part of the health care directive which allows you to appoint someone to act in your behalf in directing your medical treatment if you are not able to speak for yourself or make sound decisions. The health care power of attorney goes into effect when your physician decides that you are no longer able to understand the nature and the consequences of your treatment decisions.

The term for the person appointed to make these decisions is health care agent (proxy). It is most commonly a family member or close friend who fully understands your treatment wishes. The proxy cannot be a physician or other health care provider involved in your treatment though. 

With the exception of state restrictions or limitations listed by you on the power of attorney form, your health care proxy will make all decisions with regard to your treatment once the medical power of attorney goes into effect. Therefore, it is very important that the proxy have a good understanding of your wishes.

In order for the document to be official and legal, you must fill out and sign the medical power of attorney form. Your health care agent must also sign the form. You can revoke the document at any time.

The do not resuscitate (DNR) form is the part of the advance directive for health care that allows you to instruct healthcare personnel to not attempt to revive you if you stop breathing or your heart stops beating. Unless the form exist and is visible medical personnel will assume that you consent to attempts to revive you. Those attempts might include the placement of a tube down your windpipe, chest compressions and the use of electrical voltage to stimulate your heart. 

The do not resuscitate form is particularly valuable outside of the hospital, e.g. in situations where paramedics are called to a home. In that setting, it is important to have the form visibly on display where the emergency crew can see it. Otherwise, they will attempt resuscitation if it appears to be indicated.

Medical advance directive forms can be obtained from a number of sources including medical offices, hospitals, attorneys, social workers and some post offices. You can also draft your own. Because states regulate advance directives each state has its own official living will, medical power of attorney and do not resuscitate forms. Therefore it is probably best to use your state's official forms in order to be fully compliant with all your state's laws.