Life is unpredictable. It’s a reminder of the importance of thinking about what you want to happen if you become incapacitated — no matter your age or health status.
Advance directives are one of the best ways to ensure your care preferences are honored.
Conversations with loved ones about your end-of-life care are a great place to start; even if they are difficult conversations to have. But documenting your wishes and outlining what kind of care you do or don’t want to receive in writing is also important. Having a plan in place will provide peace of mind to loved ones and remove the potential burden of having to make decisions on your behalf. Read on, or save yourself some scrolling by clicking one of these quick links to get right to your question.
- What is an advance directive?
- Setting up an advance directive.
- What to include in an advance directive?
- Should a POLST/MOLST be included in an advance directive?
- Choosing a healthcare agent or proxy.
- How should I store an advance directive?
- Updating an advance directive.
What is an advance directive?
An advance directive (also known as a living will or healthcare power of attorney) is a written, legal document that explicitly expresses your healthcare wishes should you lose decision-making ability.
It also allows you to designate an individual to ensure your wishes are honored, including decisions about when to withhold or withdraw life-sustaining treatment.
How do you set up an advance directive?
Each state has unique advance directive requirements and forms. A great place to start is finding your state’s downloadable template at CaringInfo. You can also visit FindLaw to learn more about advance directive requirements in your state.
What should be included in an advance directive?
Each state’s forms vary, but generally your advance directive will include:
- The name and contact information for your healthcare agent or proxy;
- Preferences for your healthcare should you become unable to speak for yourself;
- Names and signatures of individuals acting as your witnesses for signing the advance directive, if required by your state. In most states, witnesses cannot be your healthcare agent or proxy, one of your care providers, related to you by blood, adoption, or marriage, or entitled to any portion of your estate upon death; and,
- The signature and seal of a notary public, if required by your state.
There may be more detail you want to consider for your advance directive:
- The procedures, interventions, or types of care you want to receive in certain situations.
- Life-support technologies you want to have or deny if your quality of life falls below a certain threshold.
- Scenarios that may impact or change your healthcare wishes — including being diagnosed with a terminal illness.
- What a “good death” looks like in contrast to what defines a life worth continuing to live.
- The point at which you want to prolong your life and/or preserve resources for other people.
- A list of people who you do not, under any circumstances, want to make healthcare decisions on your behalf.
- What you want to happen to your body when I die. Do you want your organs donated if appropriate? (Learn more about funeral and body disposition arrangements here.)
Should a POLST/MOLST be included?
In some states, a physician orders for life-sustaining treatment (POLST) or medical orders for life-sustaining treatment (MOLST) are included in the advance care directive template. These documents are specifically for people diagnosed with a serious illness and expected to live one year or less.
They are not meant to replace your other directives. They provide directions for your healthcare provider for specific health-related emergencies or conditions. Provisions covered in this document may include medical interventions vs. comfort care; resuscitation/intubation orders; and, nutrition and/or hydration wishes.
How do I choose a healthcare agent or proxy?
An ideal person for the job is someone who:
- Excels at making difficult decisions under pressure;
- Is diplomatic and empathetic – who can balance the needs, wants, and unpredictable emotions of your loved ones;
- Isn’t afraid to ask the tough questions that will arise when discussing someone’s end-of-life care;
- Is easily reachable by email, phone, and/or text; and,
- Is or can easily be within physical proximity of where you’re likely to receive care.
Once you determine the individual, let them know your wishes and ensure they are up for the task. Have multiple conversations with them to ensure your wishes are heard and understood. You may want to make them aware of any key players in your life who are likely going to be invested in your health outcomes, and how best to handle those people in situations when emotions will be running high.
It is important to appoint an alternative healthcare agent or proxy in case yours becomes unavailable. Identity and inform this person of your wishes, and make sure to include them on your advance directive form.
How should I store an advance directive?
You should save the original copy in a safe and accessible place at home. You can also upload it to the U.S. Advance Care Plan Registry (for a fee) where doctors are able to access digitized copies. The Registry also allows you to download a wallet advance directive card from this website to keep with you when you travel.
A copy of your advance directive should be shared with:
- Your primary and alternate healthcare agents or proxies;
- Your doctor(s). Ask your providers to upload it to your medical chart; and,
- Optional: any family members, friends, or other important people in your life you want to understand your end-of-life care preferences.
It’s a good idea to note on each copy where the original is stored, in the event it is required.
Can you update an advance directive?
Yes! You can make updates at any time – if you receive a new medical diagnosis, your marital status changes, or your end-of-life wishes evolve.
Once you revise your form, destroy your old copies, and make sure to share new versions with the appropriate parties and replace your original in a safe place.