As long as a person is competent, capable of making decisions, and able to communicate their decisions about accepting or rejecting medical treatment, there is no need for advance directives. However, there are times when people are not, either physically or mentally, in a position to make any decisions for themselves. During these circumstances, it is important to outline advance directives.

If a person suddenly slips into coma or suffers cardiac arrest, how will they convey to the doctor the kind of treatment they would like to receive under these conditions? Who will make decisions for them if they are unable to do so?

Taking into account the importance and sensitivity of such critical situations, people have a legal right to receive the kind of treatment they would like to have even when they are not in adequate decision-making condition.

Advance Directives

An advance directive is a document with specific instructions, prepared in advance, that tells the doctor the kind of treatment and care the patient wishes to receive, in the event that patient loses their ability to make decisions in the future. The patient’s inability to make a decision or the inability to communicate their wishes could be the result of a terminal illness, life-threatening injury, coma, or an illness that affects their faculties such as dementia.

If a person is admitted in the hospital with a life-threatening illness or terminal illness, the hospital management staff, nurse, or attending doctor will usually talk to the patient about advance directives upon their admission. Advance directives are documents, signed by the patient, outlining the patient’s wishes about treatment choices in certain circumstances. These documents also designate a power of attorney, stating the name of the person whom the patient appointed to make decisions on the patient’s behalf.

Advance directives only take effect if the doctor determines that the patient lacks the capacity to make their own health care decisions.

The laws for advance directives vary from state to state and sometimes states combine forms. Information regarding the specific laws in the state of residency can be obtained from the state bar association, state medical association, state nursing association, hospitals, and private health care centers.

There are three primary types of advance directives:

• Living Will

• Durable Power of Attorney for Healthcare

• Do Not Resuscitate, or DNR

Living will

A living will is a written legal advance directive that specifies the person’s wishes and needs in the event that they are unable to communicate them to the doctor. It allows the person to outline what kind of medical treatment they do or do not want to have in the event of serious or terminal illness.

A living will also allows the person to ask for all the available options for treatment. As with every type of advance directive, the living will take effects only if the doctor determines that the patient lacks the capacity to make their own health care decisions. A living will should include the following procedures and treatments:

• Artificial nutrition through intravenous or tube feedings

• Prolonged maintenance on respirator (if unable to breathe on their own)

• Blood transfusions

• CPR (if cardiac arrest occurs)

• Blood cultures, spinal fluid evaluations, and other diagnostic tests

The living will also specifies the person’s wishes to donate their organs; however, a living will does not allow the patient to designate someone to have a durable power of attorney for healthcare.

A durable power of attorney, or DPA, for healthcare is another kind of advance directive that designates the name of the person that the patient trusts and chooses to make healthcare decisions on their behalf. As with all advance directives, a DPA is activated only after the patient is unconscious or unable to make their own decisions. A DPA for health care gives the DPA the power to do the following:

• Offer or reject consent for any medical treatment, unless it interferes with the living will of the patient

• Decide on specific medical facilities for the patient

• Decide which doctors and medical personnel to consult

• Approach the court and decide whether the patient should receive treatment or be withheld medical treatment

• Make decisions about the way the patient’s body is handled after death, specifically this usually refers to organ donation as long as these decisions agree with the patient’s living will

• Access medical records

• Visitation rights

Another form of advance directive, a do not resuscitate (also called a DNR), dictates the patient’s request not to have cardiopulmonary resuscitation, or CPR, if the patient’s heart stops or if the patient stops breathing.

A DNR form communicates clearly to the doctor that the patient does not want to be resuscitated and the form will be added to the patient’s medical chart. Resuscitation measures include, but are not limited to, the following:

• Chest compressions, or CPR

• Assisted ventilation (breathing)

• Endotracheal intubation, breathing facilitated through a tube

• Defibrillation

• Cardiotonic drugs, drugs that stimulate the heart

The DNR form will be placed along with the medical records of the patient; it is accepted in all hospitals. A DNR does not affect the provision of other medical treatments and facilities to the patient. The patient can also make the DNR wish officially known to everyone.

By creating an advance directive form, the person is sparing friends and family members from having to make important and very difficult decisions during a critical and stressful time. Advance directives also provide a way for the person to communicate their wishes or preferences about the medical care they would like to receive, before the patient is in a position where they are unable to make those decisions.

An advance directive can be prepared by any person who is older than 18. Individuals who are terminally ill are encouraged to have some type of advance directive. However, a healthy person can also have an advance directive in case of a sudden accident or serious illness.

Advance directives can be written by filling out a form given by the doctor or the patient can write down their wishes in their own words. A patient may opt to contact a lawyer or simply use an online template for legal documents.

Advance directives typically do not have stringent legal guidelines; however, the document should be in accordance with state laws. The person can contact a lawyer and doctor and tell them their wishes to confirm that the documents are communicating the correct intentions and to avoid future confusion. When the advance directives are satisfactory, they should be notarized and copies should be given to family members and doctors.

If necessary, it is possible to change the advance directive anytime as long as the person is considered to be healthy and of sound mind and body. When changing the documents, the person should be able to make decisions rationally and should also be able to communicate those wishes calmly and clearly to the doctor and family members.

After making the necessary changes, the document should be signed and notarized according to the laws in the state. Make sure to inform all the family members and the doctor about any changes made to advance directives. If the person wishes to change his advance directive while in hospital, it is does not have to be in written form; the person can just communicate their wishes to the doctor and family members. In this instance, the verbal wishes made in person will be executed in place of the written advance directive.

Conclusion

An advance directive actually lessens the burden on family members and relieves them of making life and death decisions amidst critical situations. It is a good idea for everyone to have advance directives in place to ensure their wishes are carried out in the unfortunate event that the person is unable to communicate those wishes to family members and medical personnel.