We never know what’s around the corner, but there are always ways to plan for the unknown. Asking “what is an advanced directive” is the first step to protecting your personal choices. There are legal avenues we can take to ensure our dignity and wishes are respected no matter the circumstances, even when we’re incapacitated and unable to speak for ourselves. During some of these unexpected life events, advance directives show their value.
An advance directive is a catch-all phrase that refers to legal instructions that outline your wishes in certain situations. The purpose of an advance directive is to be your voice, representing your values and preferences if you cannot express your wishes yourself. Advance directives include Do Not Resuscitate (DNR) orders, living wills, Portable Medical Orders (POLST) and more. If you’re planning for the future, it’s a good idea to include some advance directives so that you can ensure you maintain your dignity when you are not able to speak up for yourself. Let’s get into more detail about advance directives and how to plan them.
The advanced directive meaning is exactly what it sounds like: a directive made in advance. These are instructions laid out in legal documents that represent your values and your preferences in specific situations. The purpose of advance directives is to inform the people around you of what your wishes are if you are unable to do so yourself. These documents represent you and your values and protect your dignity and humanity in trying times. Often, your advance directives will involve decisions made in medical situations and can help inform your doctors and caregivers about what you would have wanted.
While advance directives are commonly part of our end-of-life planning, people of any age and at any stage of life can benefit from creating advance directives. The unexpected can happen to anyone at any age, making these legal documents powerful and essential for anyone.
What is the purpose of an advance directive? Advance healthcare directives are a crucial part of end-of-life planning because they enable you to make choices for yourself that will impact the end of your life and your passing.in death. Like a will, your advance directives represent you when you are not physically able to speak on your own behalf. It’s essential to lay out your preferences ahead of time, in the future event that you become terminally ill, have an accident or find yourself in a coma. You want your body and personhood treated with the respect it deserves, even if you’re unaware. Your advance directives will accomplish this for you, ensuring dignity until your last moment.
Advance directives are living documents, which means they can be modified and changed throughout your life as your values and opinions change. As we grow, we mature, and our experiences mold how we see the world. That can lead to differences in how we would like to be treated in our final days. A living document allows for those changes, should they arise.
A thorough advance care directive document will cover a range of different medical decisions that your doctors and caregivers could face. Addressing these possibilities now, in a legal document, ensures that those doctors and caregivers understand and can abide by your wishes. Try to include some of the most common medical situations and ask yourself how you would like to be treated in those circumstances. Consider your value system, which might consist of consulting any faith-based advisors you have or speaking with partners and loved ones. Ultimately, however, the decisions contained in your advance directive should be yours and yours alone.
Here are some of the medical decisions you can include in your advance directive:
CPR is cardiopulmonary resuscitation, a procedure that can be performed on someone by anyone, not just a medical professional. The purpose of CPR is to get the heart beating again if you have no pulse or an irregular heartbeat that could lead to death. In your advance directive, you can indicate whether or not you would want to be resuscitated this way. These procedures are life-saving and can extend your life, something for which you may wish to express your desire. Consider the fact that successful CPR can come with injuries to your ribs and lungs and, depending on how long your body went without oxygen; you could have long-lasting effects. You might also consider, under this heading, identifying how you feel about being treated with defibrillators or other electric devices designed to restart the heart as well as medications and other treatments. Some may want doctors and other caregivers to do all they can to resuscitate them, while some people prefer not to undergo these treatments. Your decision should be written down in straightforward language, and you are not required to explain why you arrived at your choice.
Ventilators can be required while fighting pneumonia, covid-19 and other diseases that target our lungs. When we cannot breathe on our own, a ventilator can take over for us. However, the process of accessing your lungs with the ventilator tube, known as intubation, can be quite painful and require painkillers. Tracheotomies are also a common way to connect patients to a ventilator and require a small incision in the neck to allow the ventilator tube to connect directly to the trachea. Though they sound painful and scary, these are life-saving medical procedures that you may want to exhaust in an effort to extend your life. However, you may also want to consider how long you would be willing to have a machine breathe on your behalf. When you are connected to a ventilator, you cannot speak, so it’s best to make your wishes clear beforehand in an advance healthcare directive.
More commonly referred to as a feeding tube, artificial nutrition is when a tube is fed through your nostril to your stomach to deliver food if you cannot eat. The prolonged need for a feeding tube might mean that your tube has to be connected directly to your stomach with a small incision. To stay hydrated when you can’t drink, you will be connected to an IV that keeps a steady flow of fluids running to your body.
A feeding tube prevents malnutrition, and an IV will prevent dehydration. Both malnutrition and dehydration can exacerbate any pain you’re already in, as well as cause more. This may be reason enough for you to direct your healthcare providers to continue with both of these treatments as long as possible. However, neither artificial nutrition or hydration can effectively prolong your life in an end-of-life situation and can drag out painful and undignified scenarios that may not be how you envisioned you would spend your last days. Consider how you feel about these medical processes and decide whether or not you would want to be kept alive on feeding tubes and IVs if the situation is already terminal.
If your kidneys fail, dialysis can fill in. It’s a treatment that performs the kidney’s functions in a machine outside of the body. Kidneys filter waste and toxins out of the blood, so your body can circulate clean blood more efficiently. These bean-shaped organs help to control your blood pressure by maintaining a good balance of minerals, salts, and water in your blood.
A dialysis machine will pull your blood from your body, filter out everything that isn’t needed and send your blood back into your body cleaned up. An advance directive can indicate which situations you would want dialysis to continue or stop. Dialysis is a life-saving medical tool that can improve people's lives who can otherwise function normally, and it can prolong your life. You may want to live with the need for dialysis for as long as possible. Conversely, when a patient is no longer able to live independently and needs round-the-clock care, dialysis may just be prolonging pain and discomfort. If you’ve suffered brain damage, have no mobility or are experiencing a total loss of quality of life, you may want to ask for dialysis to stop.
Since the advent of organ transplants, the waiting list for much-needed organs has been heart-breakingly long. At any given time, there are over 100,000 people on the organ transplant list in the United States desperately awaiting the news that a life-saving transplant can finally be done. Many of us have chosen to take one final selfless act in death and give life to those who need it by becoming organ donors. However, there are many reasons not to donate your organs, such as cultural and religious beliefs, discomfort and fear. No matter what side of this issue you land on, your health care providers need to know if they can donate your organs after you pass. Including your organ donation preferences in your advance directive can accomplish that for you and ensure that nothing is done with your organs that you disapprove of.
Comfort care is also known as palliative care and is, simply put, the management of pain and comfort in the final months and days of your life. Palliative care is often used for terminal patients, and there are a few decisions to be made that fall into this category. First, you can decide when the medical poking and prodding stops. There comes the point when tests and treatments for a condition that will not improve are causing more discomfort than eliminating. You may also wish to remain at home until the end so you can be surrounded by the people and things you love. To that end, you may choose to limit or specifically define who can see you in such a condition, as you may wish to keep any children in the family from the trauma it may cause, or request that certain loved ones be present to bring comfort and support. Decisions should also be made about what pain medications you’re open to and how much and when to change the focus from prolonging life to increasing comfort.
As an advance directive is a legal document, it is best to start by looking into what your state requires to recognize a document as legal. You may need witnesses, or you might be required to get your advance directive documents notarized to have them recognized legally in your state. You may even be able to find forms issued by your state to fill out for a living will or advance directive.
Once you know your state’s requirements, start thinking about what you want to include in your advance directive. Discuss your decisions with your family and loved ones so that they are aware of what your wishes are. If you are naming a power of attorney in your advance directive, speak to that person and confirm that they are comfortable serving as your voice in the event you can’t speak for yourself. Speak with your health care providers and discuss your decisions with them so that they are on the same page and understand your wishes.
When you know what you want to include in your advance directive, write it down. Advance directives must be recorded in writing, and you can use templates and forms designed to help you with this process found all over the web. Ensure you get your witness signatures and/or notarization to finalize your advance directive and then keep the originals in a secure place.
At this point, it’s always a good idea to give copies of your documents to anyone you named your power of attorney, your doctor and your lawyer if you have one.
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Not only does everyone’s advance directive look different, but yours may change and adapt in the years to come. When you first create your advance directive, it can be simple and list your preferences on a single page. As you get older, learn more and understand how you want your final days to look, you may consider adding more details. That could mean more documents for specified purposes and include orders for who to consult and what to do in certain situations. A few different types of documents can be included in your advance directive that serve various purposes. Let’s take a look at some of these specified documents you can have in your advance directive:
Unlike your last will and testament, a living will does nothing after you have passed. Instead, a living will is a document containing all of your instructions, preferences, and wishes for medical care if you cannot speak for yourself. A living will is a type of advance directive, which is an umbrella term that includes medical decisions and the power of attorney, healthcare surrogates and proxies, non-medical care directives and more. Your living will is strictly for listing your wishes regarding medical procedures, treatments and medication.
Your living will should be a separate document included in your advance directive and signed by witnesses or notarized. Most states have a living will form that you can download and fill out and then take it to your local notary to legalize it. Your living will is one of the documents in your advance directive that should be copied and given to your health care providers.
Your durable power of attorney is someone who you have selected to become your health care proxy. That means that the person you have chosen will be able to legally make decisions on your behalf in the event you are unable to do so on your own. It is a good idea to speak to the person you want to serve as your power of attorney and confirm that they are willing and able to fulfill the role for you. Your state may have specific requirements for anyone you might select to be your health care surrogate, so make sure your choice meets those qualifications before making your final decisions on who will play that role. You’ll also want to choose someone you trust who understands and respects the values that have informed your advance directive decisions. Most states will have downloadable power of attorney forms that you can fill out, sign, and notarize if required. These papers should be included in your advance directive to cover any scenarios not addressed by your living will and other documents. It’s also good practice to give a copy of your power of attorney forms to the person you have chosen to be your healthcare proxy.
DNR stands for Do Not Resuscitate, and a DNR order is a legal document that covers your preferences in the event you stop breathing or your heart stops beating. This order requests that doctors and other caregivers not perform CPR or use defibrillator technology to restart your heart and bring you back to life. You may want to include this order in your advance directive when you are facing a painful terminal illness; you’ve suffered brain damage or struggle with debilitating dementia and other conditions that completely strip all quality of life. In these scenarios, some feel it is more humane to let a patient pass peacefully than to bring them back to a life they can no longer enjoy. A DNI order is similar to a DNR, but it deals with intubation when you require a ventilator to breathe. The forms for these orders can be downloaded from many different places across the internet, quickly filled out and included in the rest of your legal advance directive documents.
POLST stands for Portable Orders for Medical Treatment, and MOLST stands for Medical Orders for Life-Sustaining Treatments. A POLST form is valid in and out of medical settings and can communicate your wishes regarding specific scenarios. For instance, it can instruct caregivers not to take you to the hospital under certain circumstances or identify medical treatments you do and don’t want. A MOLST form is an approved legal form available in some states that covers many of your medical decisions addressed in your living will. You can download both forms from state government websites and nonprofit organizations.
Organ and tissue donation forms are available in most states, and some will indicate your preferences on your government-issued ID. You can find out how to become an organ donor and where to download the forms in your state by visiting this user-friendly website and selecting your home state. Follow the instructions for the state you reside in, and be sure to include any of the legal documents required by your state for organ donation in your advance directive.
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