Advance Health Care Directives
The Advance Health Care Directive (AHCD) is a way to make your healthcare wishes known if you are unable to communicate. The AHCD tells others what kind of medical treatment you would want, or would not want, if you had a serious illness or injury. The AHCD also lets you name someone you trust to speak for you if you cannot speak for yourself; this person is described as your “agent” or “surrogate decision-maker.”
Everyone, age 18 and older, should complete an AHCD, as an accident or a chronic illness can affect any one of us. Your AHCD is only used if you are unconscious or too ill to communicate; at all other times you will express your own decisions about your medical care.
Three things help you receive the type of care you would want during critical illness or near the end of your life:
- Completing an AHCD
- Talking about your wishes with your family
- Talking about your wishes with your doctor
The medical system is legally obligated to provide all medical treatments in an emergency, including cardiac resuscitation and advanced life support, unless there has been legal documentation, such as an AHCD. Both your physician and your "surrogate decision-maker" are obligated to try to provide the type of treatment that they believe YOU would choose in that situation.
Legal Issues and Self-Advocacy
Many hospitals and physicians today ask, upon admission, if you have taken care of legal matters such as setting up a health care power of attorney, drafting medical directives, deciding upon organ donation, and related topics.
In the past few years, these topics have become easier to discuss with families and friends. There are a wealth of resources available to develop these documents:
- A power of attorney is a formal document that allows someone else to act as your legal representative and to make binding decisions on your behalf.
- A medical power of attorney, also known as a healthcare proxy, is one type of healthcare directive that communicates your wishes in case you are not able to express this information due to a medical emergency or situation.
- A will is a legal document that outlines what you want done with your property after you die.
- A medical directive lets family and the medical teams know what treatments you want or don’t want. It is also called an advance directive.
There are many sources for developing these documents. A lawyer can help you put them together. Most hospitals provide medical forms to patients. The internet can provide some forms, but be sure they will be legal in your state.
- CaringInfo (formerly Caring Connections) has free, specific state Advanced Health Care Directive (ADCD) forms which you can download in either English or Spanish. Call 800-658-8898 or email at email@example.com.
- An on-line, free advance health care directive site is My Directives.
- Prepare for Your Care walks you through the medical aspects of your preferences, and is available in Spanish and English.
- “Five Wishes" is another popular AHCD (cost: $5)
Organ Donor: If you want to be an organ donor, tell your family and your caregiver(s), in addition to indicating your wish via a driver’s license or other document. Click here for a site that will help you designate your wish to be a donor. State departments of motor vehicles, division of drivers’ licenses, are the locations where most potential donors register, through their driver renewals. Some states have donor registries.
The AHCD may look long, but is actually not hard to complete. There are key items to complete:
- Who can speak for you if you cannot speak
- Identify if you want life sustaining treatment if you are terminally ill, or in a coma and not expected to recover
- Organ and tissue donation instructions
- Your signature
- Two witnesses whose signature validates that you signed the form
- You can personalize your AHCD to include preferences for quality of life considerations, physician preference, etc.
When you have completed your AHCD, give copies to:
- Your doctor to place in your medical record
- Your agent or surrogate decision-maker
- The hospitals where you are receiving medical care
- A trusted family member who can keep a copy of your AHCD in a known location, and
- Be sure to talk with your family about your wishes and values
The Conversation Project has tools and videos to help you talk with your family and close friends about your medical wishes.
Check your document periodically as your circumstances, wishes, and family situation may change. Find out if your state requires updating specific documents. Older advance directives may not be as comprehensive as more recent AHCDs.
- Older forms of advance directives include Living Wills and Natural Death Acts. These forms state that you do not want life-sustaining treatment if you become permanently unconscious or suffer from a terminal disease. Many states no longer promote the use of these forms, and encourage completion of an AHCD to both state your wishes and name your surrogate decision-maker or agent.
- For those who are medically frail or seriously ill, doctors may recommend an additional form, such as a POLST (Portable Medical Orders) to further clarify their specific medical wishes.
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