Types of healthcare directives

Making end-of-life wishes can be daunting, especially in the face of a terminal illness or serious injury. Where it concerns your healthcare and preferred medical treatment, preparing an advance healthcare directive is a smart and practical thing to do. Preparing ahead of time can make difficult healthcare decisions less stressful.

Understanding advance directives

An advance directive for healthcare is a written legal document that states your healthcare wishes in the event that you are unable to communicate or make decisions. Usually, this is when you are medically determined to be permanently unconscious or terminally ill by at least two physicians.

In this document, you appoint an individual to be your agent that oversees executing your wishes and preferences regarding provisions of healthcare by healthcare providers such as doctors, nurses, specialists, etc. Each state has its own requirements for eligibility.

Depending on the state in which you reside, terminology, content, revocation, and healthcare laws differ. These variances will greatly determine who you can appoint, what treatment you can withhold or request for, and how you can revoke or change your directive.

Is a living will the same as an advance healthcare directive?

A living will is a declaration of your healthcare wishes. It does not normally include appointing a power of attorney. An advance healthcare directive is both a living will and a power of attorney.

A living will is also referred to as a healthcare declaration, directive to physicians, healthcare directive, or an advance medical directive.

A power of attorney, on the other hand, is also referred to as a medical power of attorney, power of attorney for health care, designation of surrogate, healthcare power of attorney, and patient advocate designation depending on the state in which you reside.

What is a healthcare agent?

A healthcare agent also referred to as a patient advocate, healthcare proxy, surrogate, or healthcare representative is an individual you appoint in a durable power of attorney. Once the power of attorney is signed and dated, the person is authorized to execute your healthcare wishes should you be unable to make healthcare decisions yourself.

You limit the agent’s authority by adding details to the power of attorney that explains what they can and cannot, do on your behalf. State law may also limit the agent’s authority over your healthcare. The power of attorney is usually accompanied by a healthcare declaration.

Usually, an agent is a close friend or family member over 18 years of age. The following are normally restricted and cannot be appointed as a healthcare agent:

• A healthcare supervisor, employee, operator, or owner of a healthcare facility in which you are receiving treatment or reside
• Your attending physician unless he/she is a relative by blood or marriage
• Your conservator.

Make sure to check your state requirements as states have different variations and/or requirements for agent eligibility.

What is a 'do not resuscitate order'?

A DNR or “do not resuscitate order,” is a directive given by a patient when they do not want to receive cardiopulmonary resuscitation (CPR.) This order is not a directive in itself. It is only a supplement to other healthcare directives included in the patient’s healthcare declaration. This order is usually made by patients who are critically ill and do not want to receive further treatment in the event that they become unconscious.

What is a POLST form?

A POLST form or “physicians order for life-sustaining treatment” is a document used to add more detailed instructions, wishes, and healthcare preferences. It could be about artificial nutrition and hydration, medication, intubation, and other methods by which a physician might perform life-sustaining treatment.

Changing or canceling your advance healthcare directive

In most cases, to cancel a directive, you make a written statement revoking your directive. A written statement must be signed and dated in the presence of witnesses.

In order to make changes, written statements that unmistakably express the changes you want are acceptable. Otherwise, you may revoke the original advance directive for health care by executing a new one following your state’s formal requirements.

Please take note that depending on the state in which you reside, the requirements for advanced healthcare directives, declarations, and powers of attorney will vary. It is best to check your state’s requirements and procedures before making your directives to be sure they will be executed properly should you ever need them.