Advance Care Directives: Preparations for the Unforeseeable Future

AgingCare.com   |   Updated August 17, 2018

An advance directive is a legal document in which a person spells out their health care preferences for use in the event that they become unable to make decisions for themselves. Drafting one provides invaluable guidance and peace of mind for family members and medical professionals.

In caregiving situations, it’s a good idea for seniors to draft an advance directive if they haven’t already. It’s impossible to predict if/when a car accident, stroke, heart attack or other illness may strike, rendering someone incapable of making their own medical decisions. Because of this, these legal documents are important for people of all ages, including caregivers themselves.

Without these instructions, family caregivers are often conflicted over what kind of treatment their loved ones would have wanted in emergency or end-of-life situations. In the absence of any specific preferences, doctors are legally required to pursue all viable life-sustaining treatment options. These measures can be very extreme, and many frail and chronically ill individuals choose to opt out of specific interventions.

Advance directives can provide guidance in the following health care decisions:

  • The use of equipment such as ventilators and dialysis machines.
  • The use of cardiopulmonary resuscitation (CPR).
  • The use of artificial nutrition via tube feeding and/or artificial hydration via IV.
  • Treatments for pain, even if a person is unable to make other decisions (this may be called comfort care or palliative care).
  • The decision to donate organs or other body tissues.

The Components of an Advance Directive

Advance directives go by different names in different states, but they are usually comprised of two main components: a living will and a durable power of attorney for health care.  Add-ons such as do-not-resuscitate (DNR) orders, physician orders for life-sustaining treatment (POLST) forms, and organ and tissue donation requests may also be part of a person’s advance directive.

A living will states a person’s medical wishes that will guide their health care if they become mentally or physically unable to make decisions. The difference between this and a regular will is that the living will guides decisions before death while a standard “last will” guides decisions after death. A living will is used to declare desires to not have life-prolonging measures taken if there’s no hope for recovery, such as in the event of brain damage or terminal illness.

A durable power of attorney for health care, or health care proxy, designates who can act on the incapacitated person’s behalf to ensure that they are cared for in accordance with the wishes explained in their living will.

Because state laws vary, it’s important to ensure an advance directive complies with current legal requirements, such as witnessing or notarization. An attorney can assist with drafting a valid advance care directive. Local hospitals and seniors’ organizations, such as Area Agencies on Aging, may be able to help as well. In Tennessee you can find state-specific advance directive forms at https://www.advancedirectivestn.org

Discussing Health Care Wishes

It’s crucial to discuss health care options, possible scenarios and personal preferences with a physician prior to executing an advance directive. Once the document has been drafted, its contents should be reviewed in detail with the person selected to act as power of attorney for health care.

Broaching such a heavy topic with a loved one can be difficult, but it’s crucial to find opportunities to talk about advance care planning. Try using an example, such as a newspaper article about advance care directives or the experience of a friend or relative, to broach the topic. You can also try mentioning that you are considering drafting an advance care directive for yourself.

If you find that your loved one resists talking about this subject, ask a doctor to help. Medical professionals, especially those who deal with older or seriously ill patients, are usually well versed in these matters. You can write the doctor a note requesting that they raise the topic during your loved one’s next appointment.

Finalize the Legal Preparations

Desires for health care and end-of-life care cannot be followed if they haven’t been clearly communicated to key people. Keeping an open dialogue with all parties involved will ensure everyone is informed and on the same page.

As a caregiver, check that the following steps are taken to ensure your loved one’s documentation is both current and valid:

  • Make sure the documents have been signed in front of witnesses and/or a notary public. Requirements vary by state.
  • Provide all doctors caring for the patient with a copy of the advance directive. Keep a copy handy yourself.
  • Make sure anyone named as an agent in a health care proxy has a copy of that document and knows the patient’s goals for medical care.
  • Explain the patient’s healthcare wishes to other family members as needed.
  • Realize that more than one discussion with doctors and family is warranted. Revisit the advance directive annually or whenever big changes occur in your loved one’s health to be sure the document still reflects their needs and wishes.
  • When a person is admitted to a hospital or long-term care facility, request to review their advance directive with their physician and have a copy added to their medical chart.

Such documentation takes the guesswork out of what care a person wishes to receive and to what extent they desire their life to be prolonged. Having these instructions expressed in writing removes the uncertainty of what is desired and what is not. Currently, only 25 percent of Americans have recorded their end-of-life medical wishes in a legal document. This is a problem, as more than half of patients are unable to participate in these decisions when they need to be made. If we don’t spell out our wishes in a healthcare directive, the decisions are up to doctors who may not know us, or conflicts may arise among our loved ones over what our wishes would have been.