How Much Do You Know About Advance Directives?

A regular will is a document that states how you want your estate handled after your death, according to the National Hospice and Palliative Care Organization (NHPCO). It takes effect after you die. A living will is a document that states what kind of medical care you want (feeding tubes or artificial breathing, for example) if you are too ill to make that decision. It does not go into effect unless you are incapacitated because of illness. It does not allow you to name someone to make medical decisions for you. A durable power of attorney is another kind of advance directive. In this, you name a person who will make medical decisions for you if you are unable to make them yourself. A third kind of advance directive is a do-not-resuscitate (DNR) order. This means you do not want medical staff to try to revive you if your heart stops beating or if you stop breathing. Another form of advanced care planning is the Physician Orders for Life-Sustaining Treatment (POLST). This is a set of portable medical orders signed by your healthcare provider. Some states call them Medical Orders for Life-Sustaining Treatment (MOLST). POLST and MOLST orders are for a certain set of people who are seriously ill or have advanced frailty. They are not for healthy people. They provide specific medical orders about treatments. And they travel with you should you not be able to communicate your wishes.

The person can be anyone you choose—spouse, son, daughter, or friend. The person does not have to be a lawyer. The durable power of attorney document—also called a healthcare proxy, healthcare agent, or healthcare surrogate—can include specific instructions about medical treatment you want or don't want. This document is valid indefinitely, unless it lists a specific end date, is revoked by you, or the person you designate becomes incompetent. The person you select can only make healthcare decisions on your behalf if your healthcare provider declares you incompetent.

In addition to any limits you may place on the person with medical power of attorney, in general this person is not allowed to grant consent to have you committed to a mental institution or to allow convulsive treatment or neurosurgery for a mental health issue or abortion. The person also can't consent to allow your comfort to be neglected.

No state requires an advance directive. It is your decision to have one.

Just as a regular will can be changed, an advance directive can be changed or even canceled, if you change your mind. You must follow your state's laws. You should give copies of the new document to your healthcare provider and others to whom you gave the original paperwork. If you're in the hospital and you don't have time to make the changes in writing, you can make changes by telling your provider directly. Make sure to tell your provider exactly what you want to happen. Usually, wishes that are made in person will be followed in place of the ones made earlier in writing. To change your advance directive, whether in writing or by telling your healthcare team and family, you must be of "sound mind." This means you must be able to think rationally and speak clearly.

If you travel to or vacation in another state, you don't need a separate advance directive for that state. But if you move, you should prepare a new advance directive to meet the laws of the new state. If you spend a lot of time in another state, you should consider getting a second advance directive so that you are on record in both places.

The card should also state where the advance directive is located and the name of the person who will act on your behalf, if you have named one. You should give copies of your advance directive to your healthcare provider, hospital, nursing facility, and person acting on your behalf. You should let your lawyer or a family member know you have an advance directive and where it is located. Keep it in a safe but easily reached place. You can also keep your advance directive on file at the U.S. Advance Care Plan Registry. Registration is free. The information is accessible only to healthcare providers.

You can write your own, but special forms may make the task easier. Keep in mind that each state has its own requirements about advance directives. You can get a copy of the form for your state from the National Hospice and Palliative Care Organization. If you don't use one of those forms, you can use a form provided by your healthcare provider. Or you can get a form from your state senator's or representative's office. You can also have your lawyer draw up a form, use computer software for legal documents, or simply write down your wishes by yourself. If you do it yourself, it's a good idea to have your provider or lawyer review the document to make sure it meets your state's requirements.

If you wait until you are in the hospital for an illness, you may become too ill to complete an advance directive. And that's when it's most important to have one. The best time to prepare an advance directive is when you are healthy and able to think through what care you want—or don't want.

Standard advance directive forms do use vague wording, stating only that you would not want "heroic" or "artificial" treatment if you are clearly "dying." It's best to provide as much specific information as possible about the care you want or don't want. Discuss with your healthcare provider and family different medical situations and what you want to happen. If you don't want artificial resuscitation or if you don't want be put on a ventilator, for example, put that on the form. Although these issues may be uncomfortable or difficult to think about, your answers will help guide your family and caregivers.