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Advance care directives

Alternative names

Living will; Power of attorney; DNR - advance directive; Do not resuscitate - advance directive; Do-not-resuscitate - advance directive

Why write an advance directive?

When you are very ill or injured, you may not be able to make health care choices for yourself. If you are unable to speak for yourself, your doctors may be unclear as to what type of care you would prefer. And your family members may be uncertain or disagree about the type of medical care you should receive. An advance care directive is a legal document that tells your doctor what care you agree to in advance of this type of situation. With this document, you can tell your doctors what medical treatment you do not want to have and what treatment you want no matter how ill you are.

Writing an advance care directive may be hard. You need to:

  • Know and understand your treatment options
  • Decide future treatment options you may want
  • Discuss your choices with your family

Living wills

A living will explains the care you do or do not want. In it, you can state your wishes about receiving:

  • CPR (if your breathing stops or your heart stops beating)
  • Feedings through a tube into a vein (IV) or into your stomach
  • Extended care on a breathing machine
  • Tests, medicines, or surgeries
  • Blood transfusions

Each state has laws about living wills. You can find out about the laws in your state from your doctor, the state law organization, and most hospitals.

You should also know that:

  • A living will is not the same as a last will and testament after a person's death.
  • You are not able to name someone to make health care decisions for you in a living will.

Other types of advance directives

  • Special health care power of attorney is a legal document that allows you to name someone else (a health care agent or proxy ) to make health care decisions for you when you cannot. It does not give power to anyone to make legal or financial decisions for you.
  • A do-not-resuscitate order (DNR) is a document that tells health care providers not to do CPR if your breathing stops or your heart stops beating. Your doctor talks to you, the proxy, or family about this choice. The doctor writes the order on your medical chart.
  • Fill out an organ donation card and carry it in your wallet. Keep a second card with your important papers. You can find out about organ donation from your doctor. You can also have this choice listed on your driver's license.
  • Verbal instructions are your choices about care that you tell health care providers or family members. Verbal wishes usually replace those you made previously in writing.

What else?

Write your living will or health care power of attorney according to your state's laws.

  • Give copies to your family members, health care providers, and health care agent.
  • Carry a copy with you in your wallet or the glove compartment of your car.
  • Take a copy with you if you are in a hospital. Tell all medical staff involved in your care about these documents.

You can change your decisions at any time. Be sure to tell everyone involved -- family members, proxies, and health care providers -- if you make changes to your advance directive or a living will is changed. Copy, save, and share the new documents with them.

References

Kapp MB. Ethical and legal issues. In: Duthie EH, Katz PR, Malone ML, eds. Practice of Geriatrics. 4th ed. Philadelphia, PA: Elsevier Saunders; 2007:chap 6.

Marchand LR. The plan of care. In: Walsh D, Caraceni AT, Fainsinger R, et al., eds. Palliative Medicine. 1st ed. Philadelphia, PA: Elsevier Saunders; 2008:chap 120.

Updated: 5/7/2014

Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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