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What is an Advance Care Directive?

An advance care directive (ACD), also known as an advance healthcare directive (AHD), ensures that your medical wishes will be followed when you are unable to speak or are no longer in a mental state to make cogent decisions. By planning out your wishes in writing ahead of time, you provide healthcare professionals with important guidelines for medical care. The term advance care directive generally refers to two types of documents, the living will and the healthcare power of attorney, although other written and verbal instructions can fall under this category.

The Living Will

The most common type of ACD is known as the living will. Not to be confused with a Last Will & Testament, which deals with decisions to be carried out after your death, the living will is written ahead of time to explain the kinds of medical care that you wish to receive and those that you do not. It helps doctors make important decisions regarding tests, medicines, surgeries, blood transfusions, CPR and feeding tubes.

Healthcare Power of Attorney

A living will does not technically allow you to designate a person to make decisions for you. For this, you will need to turn to a healthcare power of attorney. However, these two forms can often be combined into one document. The person you choose to represent your wishes is often referred to as a health care proxy, and his or her authority will be limited to decisions of a medical nature: legal and financial decisions do not fall under his or her jurisdiction.

DNR and DNI Orders

Though DNR (Do Not Resuscitate) and DNI (Do Not Intubate) orders may be included in the living will, they don’t have to be. A DNR prevents a medic from performing CPR, and a DNI prevents the use of breathing tubes.  These orders can be communicated verbally to your physician, who will put them in his or her medical records.

Planning Your Advance Care Directive

According to the National Institutes of Health, more than one in four Americans will have medical decisions made when they are in a physical or mental state that renders them incapable of communicating their wishes. Some of these people have prepared advanced care directives, but others have not. Without an ACD, this can be a very stressful time for physicians, friends, and family members. It’s never too early to start planning ahead. Here are some tips for getting started:

Consider your family’s medical history: By examining the medical issues that run in your family, you can construct a good genetic map for determining potential health problems.  For example, if older family members have suffered strokes, you may spend some time researching strokes to determine the kinds of decisions that would need to be made if this ever happened to you.

Determine your values: What is most important to you? Would you like to be kept alive by any means necessary? If so, provide clear instructions for doing so. Or are there specific issues that would reduce your quality of life so completely that you would rather not have your life prolonged artificially? If feeding tubes and breathing machines are out of the question for you, make this known, so that physicians and loved ones don’t have to worry about making the wrong decision.

Talk to your loved ones: Once you have started to consider the medical decisions that you would like to make, bounce your ideas off the people closest to you. Ask for feedback from family members and to see what they think of your plan. Of course, at the end of the day, it’s your plan, and you don’t want to distort your wishes to conform to the will of others. But it can be useful to get the opinions of people that you trust.

Research your state laws: As is the case with most medical issues, rules and regulations on advance care directives vary to a certain degree from state to state. Be sure to research your state laws ahead of time to ensure that all of your wishes are interpreted or documented in a way that is legally valid. A lawyer can be helpful in this area, but is not required.

Seal the deal: Consult with your doctor and talk through your wishes to make sure they can be accommodated. Then, fill out the required forms according to your states laws to ensure your wishes will be carried out.

Keep it handy: Once you have completed your ACD, make sure that it is readily accessible. Provide copies for your doctor and your family members, and keep copies of it in locations where it can be easily found. It is not uncommon for people to go through the trouble of creating an ACD that cannot be located when an emergency strikes. It may be a good idea to put a copy in your wallet or the glove compartment of your car for quick and easy access.

Reviewing your ACD: If you change your mind about any issue that has been documented in your Advance Care Directive, don’t worry. You can always update it to reflect more current wishes. If you do this, just make sure that you have destroyed all previous copies to avoid future confusion.

Be Prepared

While the elderly are most in need of ACDs, people of all ages can benefit from a little preparation. Tomorrow is never promised. A sudden onset of an illness or an accident resulting in serious injury could force your family and physician to make some tough decisions. Consider taking these precautionary steps so that you can rest assured that if the occasion ever arises, your medical wishes will be followed and your healthcare team will know how to proceed.


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