Advance Directives: The Three Types

What are advance directives?

Advance directives are legal documents that allow individuals to specify their wishes regarding medical treatment and care in the event that they are unable to communicate their decisions. These documents provide instructions to healthcare providers and family members about the type of care a person wants to receive or not receive in specific situations. Advance directives can take several forms, including:

1. Living Will: A living will is a written document that outlines a person’s preferences for medical treatment in the event that they become incapacitated and are unable to communicate their wishes. It typically includes instructions about life-sustaining treatments such as resuscitation, mechanical ventilation, and tube feeding.
2. Healthcare Power of Attorney: A healthcare power of attorney, also known as a healthcare proxy or durable power of attorney for healthcare, appoints a trusted individual to make medical decisions on behalf of the person if they are unable to do so themselves. This person is often referred to as a healthcare agent or surrogate.
3. Do Not Resuscitate (DNR) Order: A DNR order is a medical order that instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a person’s heart stops or they stop breathing. DNR orders are typically used in situations where CPR would be futile or against the person’s wishes.

Advance directives are important because they ensure that a person’s wishes regarding medical treatment are known and respected, even if they are unable to communicate them at the time. It’s important for individuals to discuss their wishes with their healthcare providers and family members and to document them in advance directives to ensure that their preferences are followed.

What sort of questions are dealt with by an advance directive?

Advance directives address a range of important questions related to medical treatment and end-of-life care. Some common questions that are dealt with by an advance directive include:

1. Life-Sustaining Treatment: Do you want to receive life-sustaining treatments such as CPR, mechanical ventilation, or tube feeding if you are unable to communicate your wishes?
2. Palliative Care: Do you want to receive palliative care to manage pain and improve quality of life, even if it may hasten death?
3. Artificial Nutrition and Hydration: Do you want to receive artificial nutrition and hydration (tube feeding) if you are unable to eat or drink?
4. Do Not Resuscitate (DNR) Order: Do you want to be resuscitated if your heart stops or you stop breathing?
5. Organ Donation: Do you want to donate your organs and tissues for transplantation after your death?
6. Comfort Measures: Do you want to receive comfort measures such as pain medication and emotional support at the end of life?
7. Healthcare Proxy: Whom do you want to appoint as your healthcare proxy to make medical decisions on your behalf if you are unable to do so yourself?
8. Life Support: Do you want to be placed on life support machines if you are in a coma or persistent vegetative state?
9. Quality of Life: What factors are important to you in determining your quality of life, and how do you want these factors to be considered in medical decision-making?
10. Cultural and Religious Beliefs: Are there any cultural or religious beliefs that should be taken into consideration when making medical decisions on your behalf?

It’s important to discuss these questions with your healthcare provider, family members, and healthcare proxy, and to document your wishes in an advance directive to ensure that your preferences are known and followed.

What considerations play a part when choosing a medical power of attorney?

Choosing a medical power of attorney, also known as a healthcare proxy or healthcare agent, is an important decision that involves several considerations. Some key factors to consider when choosing a medical power of attorney include:

1. Trustworthiness: Choose someone you trust to make decisions that align with your wishes, even if they may differ from their own beliefs or opinions.
2. Availability: Your healthcare proxy should be readily available to make decisions on your behalf in a timely manner, especially in emergency situations.
3. Communication: Select someone who is able to communicate effectively with healthcare providers and family members, and who can advocate for your wishes.
4. Understanding of Your Wishes: Your healthcare proxy should understand your values, beliefs, and preferences regarding medical treatment and end-of-life care.
5. Location: Consider whether your healthcare proxy lives close enough to be readily available in case of medical emergencies or discussions with healthcare providers.
6. Legal Capacity: Ensure that your healthcare proxy is legally competent to make medical decisions on your behalf.
7. Willingness to Serve: Discuss your wishes with your potential healthcare proxy to ensure they are willing to take on this responsibility.
8. Relationship: Consider your relationship with the potential healthcare proxy and whether they are able to handle the emotional and ethical aspects of making medical decisions on your behalf.
9. Backup Proxy: Consider appointing a backup healthcare proxy in case your primary proxy is unavailable or unable to fulfill their role.

It’s important to discuss your wishes with your chosen healthcare proxy and to document your decision in a legal document, such as an advance directive or healthcare power of attorney, to ensure that your preferences are known and followed.