Advance Care Directive

7 Important Instructions to Include in an Advance Care Directive

An advance health care directive -- a legal document that tells caregivers and care providers how your parents want medical  matters handled -- should be as specific as possible. Help your parents think through all of the issues that might come up in connection with their future medical care.

Understand that these documents take effect only in fairly dire circumstances: Your parent must be unable to communicate his wishes for care personally. And most laws also specify that a patient must be close to death from a terminal condition or in a permanent coma before a directive will be enforced.

Depending on the state, the document specifying medical care may be called an advance directive , living will, directive to physicians, or power of attorney for health care. When drawing up these important documents (one for each parent), pay special attention to the issues mentioned here.

The First Three Elements of a Healthcare Directive to Consider

The name of a healthcare agent

Each parent's directive should appoint an individual to supervise that parent's medical care or ensure that each gets the type of care they want if they can't communicate themselves. However, if this is a sticking point for your parents -- if they don't know a person they can trust with this task -- it's still a good idea for them to put their wishes for the type of medical care they prefer in writing. Most state laws prevent attending physicians and other healthcare providers from serving in this role.

The name of an alternate agent

It's wise to name an alternate person to serve as the healthcare agent in case the first person named is unable or unwilling to act when necessary.

Instructions about whether your parents want their lives prolonged

Health care directives in most states allow your parents to specify which medical treatments or procedures they would want provided, including whether they'd want to be on a ventilator or to be resuscitated if their lungs or heart fail. Some other types of care commonly considered "life-prolonging" include blood transfusions, dialysis, surgery, and some types of diagnostic tests.

More Healthcare Directive Elements to Think About

Specific treatments your parents would like withheld

On the flip side, your parents may also indicate the medical care, including the treatments mentioned above, that they would want withheld if they're unable to express their wishes personally.

Instructions for comfort care

The issue of providing comfort care -- relief from pain and discomfort -- has become somewhat controversial because medical experts disagree over whether patients close to death actually feel pain and over whether some pain-relieving treatments really act to prolong life. If your parents have strong feelings about whether they'd want comfort care withheld or provided, they can include them in their directives.

Instructions regarding artificially administered food and water

Most patients close to death can't eat or drink on their own. The medical solution is to provide a mix of fluids and nutrients through the patient's veins, nose, or stomach. Controversies surround this practice, too, depending on whether it's considered to cure an illness or save a life. In most states, your parents can include wishes for whether they'd want food and water -- typically called nutrition and hydration -- withheld or provided.

Instructions for donating organs at the time of death

In a few states, your parents can designate in their directives whether they'd like to donate some or all of their usable organs when they die.