An advance directive is a legal document that gives medical providers instructions on the kinds of treatment that you are willing to receive from them. They are used if you suffer a medical emergency whilst unconscious or incapacitated and cannot knowingly consent to treatment.
Advanced directives are often used to manage end-of-life care during old age or for people suffering a terminal or chronic illness. However, they can also be created by individuals at any age in case of sudden medical emergencies.
These documents sometimes fall under a couple of different names such as:
- Living will
- Medical power of attorney
- Durable power of attorney for healthcare
- Combination advance directive
- Protective Medical Decisions Document (PMDD)
- Healthcare proxy
Types of Advance Directives
There are several types of advance directive that can be used both by patients and medical professionals. However, the two most common kinds allow individuals to pre-establish their future care preferences, these are:
- Living wills: These legal documents set out written instructions that medical professionals can consult before performing essential treatment and interventions.
- Medical Power of Attorney: In this case, the patient gives authority to a friend or relative (who acts as their Attorney-in-Fact) to consent to medical decisions for them. Usually, principals granting Medical Power of Attorney will consult with their agent either in writing or in person on what treatment they wish or wish not to receive prior to signing the form.
What Type of Advance Directive Is the Best?
The type of advanced directive that you choose will ultimately depend on your individual circumstances. The key difference between Medical Power of Attorneys and living wills is that one is better for severe and sudden illnesses whilst the other works best when you become mentally incapacitated through advanced age.
A living will is often the best option for someone suffering from a terminal illness or who wishes to plan ahead in the case of any future accidents. This is because it is usually only applicable once the patient has entered a coma or has become fully physically disabled.
Medical Power of Attorneys on the other hand are usually better suited to helping an individual prepare for old age. This is because the POA comes into effect only once a physician has judged the patient to be unable to make medical decisions for themselves.
It, therefore, gives the agent and principal control over a wider variety of medical issues and welfare decisions. Most importantly it also allows you personally to voice your own wishes in a lot of cases.
How to Get an Advance Directive
An advance directive form can either be found online or can be sourced from a local medical center. However, they must be properly completed in order to be fully effective for your circumstances.
Using a legal document builder can help make this process easier. It helps guide you through the process, to make informed decisions on the kind of treatment you would willingly consent to.
Once the form has been completed, it needs to be signed to come into effect. This might require a notary signature and sometimes witnesses depending on the state.
To register the document, you will need to follow the rules for your state to ensure the document is properly recorded so medical staff can access it in an emergency. The form itself doesn’t expire and doesn’t have to be renewed once finalized and registered.
Can Family Override Advance Directives?
A common question is whether family members can overrule an individual’s advance directive. The illness, possible death, or sudden incapacity of a close relative, unfortunately, can often bring out strong emotions and lead to disagreements on the right course of action.
Normally, advance directives can placate some of these issues by definitively setting out the patient’s wishes. However, it is possible for a family member to override documents like POAs should they need to.
This, however, usually requires the dissenting family members to bring the matter to court and for a judge to pass temporary conservatorship. This is quite rare as in most cases as it is considered good practice for family consultations to happen before a Power of Attorney or living will is signed.
Advanced directives are a great way to bring peace of mind to situations where medical intervention becomes more likely. They give elderly or terminally ill people much greater control over their wellbeing and allow their wishes to be followed should an emergency arise.
POLST Vs. Advance directives
Advance directives and POLST (Physician Orders for Life-Sustaining Treatment) are similar in that they set instructions for treating a patient ahead of time. However, there are many differences between the two.
The biggest distinction is that the instructions they give are decided by different parties. A POLST can only be created by a medical doctor attending a patient, whilst advance directives are created by the patient themselves.
The Patient Self-Determination Act
Since 1990, the right for patients to determine the health care they consent to has been written into law. This allows individuals to plan medical care and treatment plans in advance such as setting do-not-resuscitate (DNR) orders.
Once an advance directive is created and recorded it must be followed by healthcare professionals with access to it. This includes doctors, nurses, and other on-site staff but excludes emergency medical technicians (EMT).
However, having this legal instrument must always be the patient’s free choice, and healthcare providers and HMOs must not require people to have an advance directive. They must also not discriminate against patients based on whether or not they have an advance directive.