There may come a time when, due to a health crisis resulting in loss of mental capacity, you won’t be able to tell others what type of medical care you’d like to receive. Advance directives are documents that state how you want to be cared for if you are unable to make or express your decisions. These documents also appoint the go-to person you want to handle important health care decisions for you.
Answering questions about this process are two experts from the MD Anderson Cancer Center:
Margaret Meyer, LCSW, Director of the Department of Social Work, has helped many families navigate the advance directive waters since the 1990s.
Marty Smith, chief of the clinical ethics program, is a full-time clinical ethicist, acting as a consultant to doctors, patients and families making end-of-life decisions.
Information presented here is for educational purposes and isn’t intended to provide specific medical or legal advice.
What should I consider in doing advance care planning?
Think about your values. Is it important to you that:
- All options for treatment are considered?
- Your religious beliefs are honored?
- You have quality time for yourself and loved ones?
Then, think about how you wish to live. Is it important to you to:
- Be free of pain?
- Be able to take care of yourself?
- Avoid life-prolonging measures that affect quality of life?
What are the important aspects of advance care planning?
Thinking about communicating those preferences to:
- Your family
- Those who are important to you
- Your health care team
- Documenting those preferences in writing
How can I plan in advance for my care?
Advance directives vary from state to state. In Texas, there are three kinds:
- Medical power of attorney
- Living will (directive to physicians and family or surrogates)
- Out-of-hospital do-not-resuscitate order
What is a medical power of attorney?
If you complete only one document, this should be it. But it shouldn’t be confused with a regular power of attorney. A medical power of attorney is specific to your health care. It’s a legal document in which you give someone (your agent) authority to make health care decisions when you’re no longer capable of making them.
Your agent will have the authority to make all health care decisions for you or, if you prefer, to follow a more limited set of instructions that you can specify in the document. A medical power of attorney takes precedence over all documents related to health care decision-making.
What is a living will?
A living will shouldn’t be confused with a regular will. A living will helps communicate your wishes about specific types of life-sustaining medical care, but it takes effect only when you’re in the terminal or irreversible phase of illness or injury. If you sign a living will, talk about it with your doctor and ask that a copy be made part of your medical record.
What is an out-of-hospital do not resuscitate order?
While most states have medical powers of attorney and living wills, not all have this form that is signed by a physician and allows a patient to refuse cardiopulmonary resuscitation when outside the hospital. If you don’t have an out-of-hospital do not resuscitate order (DNR), health care providers, such as ambulance personnel, will do everything medically possible to start your heart and help you breathe.
Where can I learn more about advance directives?
What happens if I don’t have any advance directives?
If you’re unable to express or make your own decisions and all members of your family/support network agree on the action to be taken, there generally are no problems. However, all it may take is one dissenting member to call decisions into question.
Even if you’ve already given your health care provider a copy of your advance directives, don’t forget to share them with family members and review them from time to time, in case your thoughts and wishes have changed.
