An Advance Directive is similar to a living will and is also known as a health care directive. It’s a legal document that gives an individual - the principal - the ability to appoint an agent that will be able to make medical-related decisions on their behalf in case they become incapacitated. It also allows them to set out their wishes and plan for treatment options when nearing the end of their life. The power of the advance directive comes into play only when the principal is unable to make sound decisions themselves such as when they have advanced dementia, are in a coma, or any other condition where they’re functionally incapacitated.
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This is one of the most important documents for end-of-life planning when an individual (known as the principal) is keen on outlining what they want for their medical treatment and even what happens afterward.
While it can be used by anyone at any time, it’s commonly used in the following situations::
When a person is in a coma
A vegetative state that has persisted for some time
Serious brain injury or damage
Cognitive diseases such as dementia
Untreatable illness that leads to death (terminal illness)
Other medical situations which negatively impact cognitive function
Though an advance directive can be created well in advance of incapacitation, it doesn’t come into effect until the physician says that the principal is no longer making sound medical care decisions. There are also state laws that stipulate what kind of condition you must be in before an advance directive can come into effect.
It varies by state but common conditions are terminal illness or long-term unconsciousness. If all the stipulated requirements are met then treatment should be carried out in accordance with the instructions laid out in your advance directive.
As soon as you create the advance directive and sign it according to the stipulated requirements (the requirements vary by state) it becomes a legally binding document.
The common situations where an advance directive is used have been mentioned above but that doesn’t mean it can’t be used in other situations. If you work in a hazardous field or want an extra level of assurance about how you’ll be treated during an emergency or sudden illness then an advance directive can fulfill that role.
The way the document is written makes it easy for friends, family, and medical professionals to understand and follow through. It also alleviates some of the burdens on your family if they’re struggling to make decisions about what steps to take. Setting it up beforehand when you’re healthy and your mental capacity is at its peak will make things easier and ensure your wishes are followed properly.
An advance directive is a broad document that covers many aspects of medical care. You can choose to include or omit directions about any of the aspects listed below:
Whether or not you should be resuscitated and if so, do you prefer a specific method like CPR
How to handle it if you need to be ventilated
How tube feeding should be done (tube or something else)
Are there any medications you don’t want to be administered
How medical professionals should handle long term palliative care
Whether you’d like your organs donated and to which organization cause (if applicable)
The advance directive has multiple sections that need to be considered carefully when creating an advance directive for yourself.
A declaration that you’re currently in you’re right mind and are fit to make decisions regarding your healthcare. In other words, you know the options available to you and are exercising your legal right to decide about your own healthcare.
The next section requires that you stipulate the conditions under which the advance directive will come into effect. This will prevent someone from taking action on your behalf prematurely. For example, you may require a wait of ten days after entering a coma before the advance directive comes into effect. Keep in mind that these instructions are in addition to the physician’s approval and state laws.
Detailed instructions for your continued healthcare, your agent, and even what should happen if you pass away. This is the part of the advance directive that encompasses the things mentioned in the last section of this guide. Depending on how detailed you want to be, the document can be long or short. It’s all about your personal preferences because it’s your healthcare. If you don’t want to make these decisions now, you can leave everything in the hands of your agent.
The final section has your signature, the signature of the agent, and the signatures of the witnesses you’ve called. Keep in mind that a witness cannot be a family member or a beneficiary of the principal’s Last Will and Testament.
An advance directive can be daunting to create because there are many potentially unpleasant decisions you’ll have to make. With that being said, the more detailed it is, the easier it is for your family and healthcare team to adhere to your wishes.
If the advance directive doesn’t touch on multiple situations then your agent may have to step up and fill the gap in knowledge and make decisions for you.
It may seem like a lot to consider but that’s why it’s recommended to create an advance directive ahead of time while you’re still healthy. You can get started with the process right now on this page using the ‘create document’ button and save your progress if you haven’t decided on the details of a specific situation yet.
An advance directive is a legal document that serves as a guide for what you want when you’re unable to express your wishes personally. There is no requirement for your health care providers to follow what has been outlined in the document.
They may object on moral grounds due to your requests being outlandish or they may feel like there’s still a chance to reverse the situation and your wishes may prevent that from happening. Whatever the case, they are not required by law to follow your wishes as outlined in the advance directive. If that happens, your agent may request you be transferred to another institution that will follow your directions.
This can be prevented by communicating with your health care team ahead of time about your wishes. If they have any objections to the contents of the advance directive then they should come up ahead of time. You may be able to explain your reasons for doing it and get them to agree to your wishes. Conversely, you can make alternative plans such as receiving treatment somewhere else or possibly giving your agent different instructions.
It’s worth reiterating that the advance directive doesn’t come into effect until you’ve been determined to be incapable of making your own healthcare decisions. The attending physician needs to approve and it also needs to meet the requirements of state law. Only after those requirements are met will your agent be able to make decisions on your behalf.
When choosing an agent, there are many things to consider. Will the person be available when the time comes? An agent that lives in a different country may not be the best choice. Will the agent be able to follow through with your wishes? When someone is at the end of their life or facing a medical crisis, emotions are keyed up, and there’s a lot of pressure. The agent you choose should be able to assert themselves when it matters most and adhere to your wishes.
As a principal, you can outline how much authority the agent has and when those powers go into effect. Some things to consider include:
When will the agent take over for your medical care? Is it right after you’ve been determined to be incapacitated or should there be a waiting period?
What happens when there’s a terminal illness with no cure? Should life be extended under any circumstances or will the agent be able to use their discretion?
What will the agent be able to do after you’ve passed away? Organ donation, funeral arrangements, etc.
After you’ve determined who your agent is and what powers they should wield, it’s time to consider the specific choices related to how you’ll be cared for. This guide has already outlined the kinds of decisions you’ll need to make, not it’s time to sit down and choose what happens. Consider instructions for
Palliative or hospice care
You can get a full view of exactly what you need to consider by starting the advance directive creation process using the legal document creator on this page (just scroll up and click the button). If you get stuck anywhere just save your work and go back to it when you’re ready.
There are specific requirements for signing an advance directive which depends on which state you live in. Some require a notary public alone, some require two witnesses, and others require a combination of the two. You can view the specific signing requirements in your state here.
Keep in mind that a family member, beneficiary of the principal’s last will and testament, and a notary public cannot serve as a witness. When using our advance directive creator, you’ll be informed about the signing requirements based on the state you choose and the document will be tailored to meet those needs.
Of course, you want to properly store the advance directive and inform at least a few people where it is so it can be accessed in case of an emergency. Some states also require it to be registered with them so be sure to check the requirements in your state. Even if it’s not required, you can choose to record it in the state registry. In addition to the aforementioned precautions, store the advance directive’s location on a card kept in your wallet/purse at all times.