Which documents does someone need to ensure his medical wishes are followed when he's incapacitated?

Ideally, a person will achieve two separate goals, no matter what documents are used. He can spell out specific instructions and name someone to speak on his behalf. This might be accomplished in one document, or it might take two.

The possible need for extra paperwork is that some documents, usually those called living wills or health care declarations, just set out the individual's specific instructions. They spell out the care he does or doesn't want if he's terminally ill or permanently unconscious, usually with particular attention to end-of-life decisions such as resuscitation and artificial prolonging of life. The problem with relying solely on such a document is that it can't anticipate every possible medical scenario. Also, it doesn't grant any particular person the authority and responsibility to make sure that the person's wishes are actually followed.

Another type of document, variously called a medical power of attorney, power of attorney for health care, patient advocate designation, or something similar, names a specific person to act as the patient's "agent," "proxy," or "attorney-in-fact." This person will have legal authority to make sure the patient's wishes are followed and can make all other decisions related to his medical care, including:

• Consenting to or refusing any medical treatment or diagnostic procedure related to physical or mental health, including artificial nutrition and hydration.
• Hiring and firing medical providers.
• Admitting to and discharging from hospitals and long-term care facilities.
• Accessing all medical records.
• Giving directions regarding organ donation.

However, these power-of-attorney documents don't always include descriptions of what specific medical care someone does and doesn't want. This leaves room for arguments among family members and doctors, even though the person named in the document has the last word.

In most states, an advance health care directive permits the patient to accomplish both goals in a single document. In other states, he might need two separate documents.