How to Create an Advance Healthcare Directive

Ensure your end-of-life wishes are carried out in case of accident or illness

Doctor & patient
Who would speak for you if a serious accident or illness left you unable to speak for yourself?. Photo © Thomas Northcut/Getty Images

Who would speak for you if a serious accident or illness left you unable to speak for yourself? If a terrible car crash left you incapable of breathing on your own, for instance, would the medical staff treating you know that you would want -- or would not want -- mechanical ventilation to keep you alive? Would your spouse/partner, children, close friend or anyone else know your desires?

This is merely one example that illustrates why you should create an advance healthcare directive -- a legally binding document that you prepare ahead of time in order to specify your medical-care preferences if you cannot do so when necessary.

Advance healthcare directives can comprise several types of documents, including:
• Living will
• Designation of a "healthcare agent," "medical/healthcare power of attorney" or "healthcare proxy"
• Do-not-resuscitate (DNR) order
• Organ donation instructions
• Other specific medical/healthcare instructions

This article offers information and resources to help you create an advance healthcare directive (or just "advance directive") to ensure your end-of-life wishes are carried out in case of accident or terminal illness.

1. Obtain the advance-directive forms specific to the state in which you live by visiting the National Healthcare Decisions Day website, which maintains a list of online providers. Select one of the links beneath the "Where can I get an advance directive?" category, navigate to the appropriate page and download the form. (The National Hospice and Palliative Care Organization also offers this page, which is organized by U.S. state.)

2. Once you have obtained the correct forms, read the advance-directive documents thoroughly. Make sure you understand the nature and ramification(s) of each question you need to answer. If you find it helpful, then print a "practice copy" of the forms to fill out as you contemplate each question.

Note: You might find this step the most difficult you encounter when creating your advance directive. Not only must you directly confront the concept of your own mortality, but you will also need to integrate your views on life, family, loved ones, religion, the nature and duration of medical treatments, etc., into your answers. You might wish to discuss these end-of-life issues with your spouse/partner, children, relatives, friends, religious/spiritual leaders, medical providers, legal advisors, etc., as necessary. The following link offers additional suggestions and resources to help you: Advance Health Care Planning.

3. Next, you need to select a family member, friend or another individual to serve as your "healthcare agent," "medical/healthcare power of attorney," "attorney in fact" or "healthcare proxy." (The terminology varies by state.)

Note: Selecting the appropriate person to make medical/end-of-life decisions on your behalf if you are incapable of doing so is critical if you wish for your preferences to be implemented. While you might initially think of appointing your spouse/partner, or your son or daughter, for example, first put yourself in the shoes of each potential healthcare proxy you consider. The key question to contemplate is whether this person could actually carry out your desires -- both those you specify and, more important, those left to his or her interpretation. You might ask yourself if this individual could "pull the plug" if it came to that, or would his or her relationship with you, emotional or intellectual maturity, religious beliefs, etc., result in a medical/end-of-life decision that does not reflect your personality and wishes.

4. Once you have answered each question and feel comfortable with your decisions, record your answers/fill out the form.

5. After completely filling out your state-specific advance directive, sign the form(s) in the presence of witnesses. In addition, if your state requires it, have the document(s) notarized.

6. Next, you need to spread the word by making/distributing multiple photocopies of the official signed/notarized documents and giving them to your designated "healthcare proxy," anyone specifically named in your advance directive, your primary-care physician, family members, friends and/or other loved ones, your attorney, etc.

7. After distributing your advance directive to everyone you think should possess a copy, place the official signed (and notarized, if required) document with your other important papers. This location might be a safe, a bank-deposit box, with your lawyer, etc.

8. Finally, you should review/re-evaluate your advance directive every 2-3 years and update it if necessary. Consider this document a work-in-progress that takes a "snapshot" of where you stand at each stage of your life and, therefore, might change as you move forward. In other words, you should ensure that your advance directive not only reflects how you feel as you grow older, but you should also make sure it remains accurate after you experience a major life change, such as divorce, the death of a significant loved one, the diagnosis of a life-threatening illness, etc.

More Information to Help You Create an Advance Directive:
Hands Off! Do Not Resuscitate
Making Difficult Healthcare Decisions
Six Questions for Your Doctor about Treatment Options
What is a POLST and Do I Need One?

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