This information was reproduced with permission of Hospital Association of Pennsylvania Task Force on Advance Directives.
Q: What is an advance directive?
A. An advance directive is a means for you to tell your healthcare givers about the care you wish to receive - or not receive - should you ever become incapacitated and in a terminal condition or in a state of permanent unconsciousness. There are two forms of advance directives. One is called a living will. The other is known as a "durable power of attorney for healthcare decisions" or may also be called "durable appointment of a surrogate for healthcare decisions."
Q. What is a living will?
A. A living will is a legal paper in which you spell out your desire for care if you are incapacitated and in a terminal medical condition or in a state of permanent unconsciousness.
Q. Are living wills legal in all states?
A. Most states have laws that say living wills are legal. Most of these laws contain a form that you can use. Many doctors will honor living wills even in a state without a living will law.
Q. What is a "durable power of attorney for healthcare decisions?"
A. A "durable power of attorney for healthcare decisions" allows you to say who can make decisions about your healthcare if you are not able to make such decisions yourself. The person you authorize to make decisions is called your "surrogate decision maker."
Q. Does a "durable power of attorney for healthcare decisions" mean I have to appoint a lawyer to make healthcare decisions for me?
A. No. You are allowed to appoint anyone you wish. You should appoint someone you know, trust, and with whom you can talk over your wishes.
Q. Where can I get the forms to complete an advance directive?
A. Examples of an advance directive may be available through your doctor, hospital, or from local groups such as the offices of the American Association of Retired Persons, the local Bar Association, or county Agency on Aging offices.
Q. Must I have a lawyer to write a living will or a "durable power of attorney for healthcare decisions?"
A. No. However, if you want a "durable power of attorney for healthcare decisions," there are some legal rules that a lawyer will know best how to handle.
Q. What should I put into my advance directive?
A. The most important thing is to express your wishes or give permission to your agent to make decisions for you about receiving or not receiving certain forms of medical treatment which would keep you alive. You may also wish to indicate your wishes regarding organ and tissue donation.
Q. May I name certain treatments that I do not want?
A. If you want to name certain treatments that you would not want, you may do so.
Q. Where should I keep my advance directive and who should know about it?
A. Give a copy of your advance directive to your family doctor, lawyer, family, and to those people you have named to make decisions for you if you are unable to make them. Make sure that when there are changes to your advance directive, all old copies are destroyed.
Q. Do I need an advance directive now?
A. No. You do not have to sign an advance directive to be admitted to the hospital, or other healthcare facility.
Q. If I choose not to make an advance directive, who makes treatment decisions for me?
A. As long as you are able, you and your doctor together will decide about your care. If you are unable to communicate your wishes or to make decisions, your doctor will discuss this with your family. If you have no family, a court order may be required to decide your care.
Q. I spend several months a year in one state and several months in another. Do I need an advance directive for each state?
A. You should know the law in each state in which you live. It may be necessary to have more than one advance directive to meet the legal rules in each state.
Q. What if my doctor does not want to follow my advance directives?
A. It is very important that you talk to your doctor about this question while you are able to do so. If he or she indicates a problem in following your wishes, you have the right to change doctors.
Q. What if a person I name to make decisions for me dies before I do?
A. It is always a good idea to name a second person to make decisions in case your first choice is not available, for whatever reason.
Q. What if I change my mind about my advance directive?
A. An advance directive is only effective when you are incapacitated and in a terminal condition or in a state of permanent unconsciousness. It may be changed or canceled by you at any time. It is a good idea to review your advance directive periodically to make sure it is still in agreement with your wishes.
There are several terms that you may need to understand as you prepare an advance directive. The definitions below should help you understand some of the forms of medical treatment you will be making choices about.
- Cardiopulmonary Resuscitation (CPR) - A method used to restore stopped breathing and/or heartbeat.
- Do Not Resuscitate (DNR) - A doctor's order which alerts other healthcare givers that the patient or family, in consultation with the doctor, does not want the patient to be given CPR.
- Respirators - Machines used to assist or keep a patient breathing.
- Feeding Tubes - Tubes inserted through the nose, mouth, stomach, etc. to feed patients who are no longer capable of eating normally.
- Intravenous Therapy (I.V. Therapy) - Provides nutrition and water and/or medication through a thin tube placed in a vein.
- Permanently Unconscious - A medical condition diagnosed according to currently accepted medical standards and with reasonable medical certainty, has total and irreversible loss of consciousness and capacity for interaction with the environment. The term includes, with limitation, a persistent vegetative state or irreversible coma.
- Life-Sustaining Treatment - A medical intervention given to a patient that prolongs life and delays death.
- Surrogate - The appointment of another person to act on your behalf. Sometimes referred to as agent, proxy or designee.
- Brain Death - Complete stopping of all functions of the brain that cannot be reversed. A brain-dead person is not in a coma, but is, in fact, dead.
- Terminal Condition - An incurable and irreversible medical condition in an advanced state caused by injury, disease or physical illness which will, in the opinion of the attending physician, to a reasonable degree of medical certainty, result in death regardless of the continued application of life-sustaining treatment.
- Incapacitated Person - An adult whose ability to receive and evaluate information effectively and communicate decisions in any way is impaired to such a significant extent that he/she is partially or totally unable to manage his/her financial resources or to meet essential requirements for his/her physical health and safety.