Advance Health Care Directives and Living Wills: A Step-by-Step Guide

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Few decisions are more personal -- involving both health and death -- than those embodied in an advance health care directive or a living will, or a similar document. Some individuals want their lives prolonged by any means necessary, while others want medical treatments withheld, allowing for a natural death.

An advance health care directive lets caregivers and family and medical providers know a person's healthcare wishes if he's unable to speak for himself. The document can also appoint someone else to speak with legal authority for the person if he's unable to do so for himself.

If someone plans to set up an advance health care directive, living will, or similar document, here's what he needs to think about:

1. The person should consider how he wants to live during a terminal illness, and what his end-of-life preferences are when creating a health care directive or living will.

It's not easy to bring up the subject of dying (especially if it's your parent you're caring for). But you, the individual, and the rest of his family will gain some peace of mind if you can get him to start thinking and talking about this subject, and eventually to execute documents that set down his wishes.

  • One way many people get this discussion started is by showing the person the advance health care documents they've prepared for themselves. This both breaks the ice and gives the person a model on which to base his own documents.
  • The job is to get him thinking about what will be important to him when he is incapacitated, and particularly when he's dying, such as where he wants to be -- at home if possible, or in a hospital -- and what treatments (particularly life-prolonging ones) he wants and doesn't want.
  • He also needs to think about who he wants to make decisions for him if and when he's unable to do so himself.
  • The person should discuss these things with family, healthcare providers, and trusted advisors who will help him consider his wishes, options, and fears.
  • But remember that a conversation doesn't have the same legal force as an advance health care directive or similar written document, even if a doctor records it. In most states, only a written, signed, and witnessed advance health care directive legally must be followed by healthcare personnel and institutions.

2. The person should carefully consider whom he wants to serve as the agent to make decisions for him and support his choices when creating a health care directive or living will.

The agent the person in your care names in his advance health care directive should have several qualifications:

  • The job can be emotionally difficult, so it should go to someone who cares deeply about his welfare.
  • It should also be someone who is likely to be able to remain physically near him during a prolonged healthcare crisis.
  • And it should be someone who has a strong enough personality to stand up to family members, doctors, and hospital personnel if necessary.
  • Sometimes a trusted friend will make more objective decisions, or will follow the person's wishes more carefully, than a family member.

Whomever he winds up choosing, he has to discuss the responsibility with that person and make sure she's willing to accept it before naming her in the document.

3. Use sample forms for the advance health care directive or living will as planning tools.

Situations to address

Each individual's advance health care directive should be personalized to reflect his particular wishes. An advance health care directive should address situations such as:

  • When (if ever) the person in your care would want artificial life-sustaining treatment, such as during permanent unconsciousness or severe dementia
  • Types of life-sustaining treatment he would and would not want, such as artificial nutrition and hydration, surgical procedures, and cardiopulmonary resuscitation (CPR) -- and under what conditions
  • Instructions about other medical procedures that may arise given the person's medical history
  • Organ donation instructions
  • Pain control preferences
  • Where he wants his care (at home or at a designated nursing facility, for example)

Documents available online

Generic advance health care document forms are available from many sources, but the forms are designed to be planning tools only. They don't offer a final product -- the forms are meant to trigger but not replace communication between the person in your care (the principal) and the designated decision maker (the agent).

Still, they are useful for getting started. Most state legislatures provide official forms for advance health care directives and living wills. These examples, among others, are available online:

  • New York
  • California
  • Delaware
  • Illinois
  • Oregon
  • Massachusetts

Similar forms are provided by such groups as state medical and bar associations. For example, sample forms can be found online through the California Medical Association, AARP, and the American Medical Association.

The importance of state forms

  • Though there's no single form that must be used for an advance health care directive, an individual should use his state's standard form if it has one. He should also follow his state's signature and witness requirements. For example, most states require two witnesses to the person's signature; some states also require notarizing the document.
  • In most states, witnesses cannot include relatives, heirs, medical providers or their employees, or anyone responsible for the patient's healthcare costs. If the person in your care is in a nursing home, some states require a state nursing home ombudsman or patient advocate to witness the signing.
  • Once the document is executed, the individual should give copies to his doctors and hospital, the person he designates as his healthcare agent, family members, and other advisors. He should keep a list of individuals and institutions that have a copy of the advance health care directive, in case he ever wants to revoke or change it.

4. Update the advance health care directive or living will based on changing end-of-life wishes.

  • Encourage the person you're caring for to revisit his advance health care directive periodically, as long as he's able to do so. His feelings and choices may evolve as his situation changes -- for example, after he's diagnosed with a serious illness, or as he witnesses others going through the end of life.
  • People commonly make changes right before a major surgery. He may also change his feelings about who should act as his healthcare agent, or his original choice might no longer be able to take on the job.
  • He can terminate or change the advance health care directive as long as he has the mental capacity to do so. If he wants to make a change, he should prepare and sign a new document and have it properly witnessed again; just making handwritten changes on a previous document is not a good idea.
  • If he does execute a new document, he should send a copy to every person and institution that has a copy of the previous one, explaining that the new one replaces the old. In most cases, completing a new advance health care directive automatically revokes all previous directives, but it's always a good idea  to let everyone know personally.

about 1 month ago, said...

I'm not sick are in the hospital but I need a will done how do I go by doing this


about 1 year ago, said...

Very nice article. I wrote about what can happen if you don't have an advance directive (from my family's experience)...http://www.safebee.com/blogs/health/advance-directives-documents-let-you-die-dignity


over 3 years ago, said...

What if the response to bringing up the topic of advanced care directives, living wills illicits the response of "there's greed in this room," and "my doctor knows who I am." Of course this is the same guy who keeps repeating 'your mom died so suddenly," when actually she was sick and in and out of hospitals for about 6 months. He's 92 and he's going to live forever, why do any of this bothersome paperwork?


over 3 years ago, said...

This article reminded me that time waits for no one. In other words, I should get the forms and use them sooner rather than later.


almost 4 years ago, said...

All the pronouns referred to MALES in the above article... How about balancing FEMALE pronouns? Men are not the only humans who could use this information. Not too difficult to understand. Thank you.


about 4 years ago, said...

My Mother moved in with me about a year proor to het passing away . She had not been close to my Step Father for many years, infact she slept i completely different parts of her home. She never filed for legal separation because she didn't want to eventually split with him her property. Most of which she brought into the marriage or the home . Anyway, Mom and I made sure she had a living will. She made me her caretaker incharge of any medical decisions, the Advanced Directive-living will. In addition she made me Power Of Attorney. Two days before she passwd I remember her asking the Hospice nurse that came to my home if she could take her money out of their joint account. The nurse told her she had the right to half and believe me she wasted no time having me rush down to the bank to transfer her part into my bank account. It wasn't much but it would get me enough money to dress her beautifully like she wanted in bright red. It also purchased a funeral book , cards, and a new obituary I had to do because my step dad didn't even mention her only sibling, or get her place of birth correct. Once she passed he wouldn't allowe in her home to get any of my childhood pictures, jewery that belonged to her or my Grandmother, nothing! I have nothing but pictures that i had from some of my adult years, bur mostly after my Mom got sick. Mom passed Oct.6,2006 and my step Dad refused to honor her will! It is on file in Loudoun County, VA but I can't do anything to enforce her will! I don't have money for an attorney and I don't know where her belongings are ! Can I do anything now ? Can anyone help me get what my Mother wanted me to have?? I miss her so bad and i feel she tried to make sure I would be tsken care of only to be hurt so bad. My step Dad has not spoke to me since or acknowledged his grandchildren. They lost both grandparents the day my Mom passed.mu name is Lori Platts and I hope someone can help.


over 4 years ago, said...

Great article! Thanks for sharing with us....


over 4 years ago, said...

That the person needs to choose someone who is able to give up time and energy for a prolonged illness therefore should live nearby.


almost 5 years ago, said...

I think that it was very helpful but I still have questions that I want to ask such as does my illness cover being considered for hospice care and who do I ask to get answers...I appreciate this and look forward to hearing from you


almost 5 years ago, said...

A very informative step by step health care directives as we did at FamilyHealthFacility.com.


almost 5 years ago, said...

Arizona has site through Attorney General for self filing legal (when notarized) a Living Will & Health Care Directive. Used to be, may still be able to file with AZ secretary of State to have unique ID & Passcode on paper card sent back to person , so that any medical person can go to site and READ online your wishes anywhere int he world. both sites good to read. http://www.azsos.gov/adv_dir/Default.htm http://www.azag.gov/life_care/LCP_Packet.pdf Each STATE is unique in its laws. AZ packet also include DNR & specifics on how to filll out.


almost 5 years ago, said...

Hello Bruiser, Thank you very much for your comment. If you'd like, you can post your question in our Ask & Answer section, here: ( http://www.caring.com/ask ). Take care -- Emily | Community Manager


almost 5 years ago, said...

Both of my parents are in very poor health. I have two brothers and I'm the only girl. My husband and I have lived across the pasture from them for 29yrs, We've been here to help on everything. Just recently I was able to get them to add myself and brothers on most financial things and it was like pulling teeth. My mom acted like I was going to go to the bank and clean them out. She has never worked outside of home and knows nothing about how things are done. However, what has really troubled us is that mom and dad have power of attorney over each other and will not put any of us kids over them. We can not make them understand that should something happen to both of them and neither one could make decisions about themselves or the other that our hand would be tied somewhat. Dad is almost 79 and mom 77. Mom has mild dementia even though she says she doesn't and we have medical proof. Both can barely move and both have many health problems. They, especially mom refuse to listen to reason on many things and thinks we, the kids should not have any input on anything. However, I have to take them to doctor's appts most of the time because they don't tell the doctor's a lot of things, they can't fill out the paperwork so I do all of it and so much more. I'm tired of beating my head against a wall. They rely on us to help with all this and around the farm but no way will they put us as power of att. They've had many of their friends tell them they should but they will not listen. Any suggestions? Really need some help on this.


almost 5 years ago, said...

I've been trying to get an advance directive done since I'm the one making all the decisions. My mom is 86 but she still doesn't want to consider it for dad. Its very hard trying to explain that he will still get the best care possible!


about 5 years ago, said...

Most of the article I already knew about and fall into those categories. I fear the most about being alone via husband dying; not having enough money to support myself since life expectancy is longer--a bag lady; designating a caregiver(can't depend on sons or daughter); and coming down with Dementia which was not mentioned in the article. I'm 71 and my husband is 73 who is overweight, doesn't exercise and I can't get him on a diet, so don't expect him to live longer than me.


about 5 years ago, said...

Very helpful! Thanks!


about 5 years ago, said...

Hi bevel­, Thank you very much for your question. If you'd like, you can post your question in our Ask & Answer section, here: ( http://www.caring.com/ask ). Take care -- Emily | Community Manager


about 5 years ago, said...

Is there an online health care directive/ living will form for the state of TN.? Or possibly a standard (universal form) that could work for any state?


over 5 years ago, said...

This is useful because it provides explicit directions and notes the need to revise or update, with instructions on how to do it. It would be helpful to have links to articles on life-saving or life-prolonging interventions so that people could decide whether or not to start artificial nutrition and hydration.


over 5 years ago, said...

Great tip Anonymous! Thanks for sharing. -- Emily


over 5 years ago, said...

If you use any of these online forms, make sure you use one for the state you live in. Many states will ONLY accept their own format.


over 5 years ago, said...

Hi Lorijan, what a difficult question. I suggest you submit your question to our Ask & Answer section here: (http://www.caring.com/ask). Also, if you'd like to learn the basics or DNR orders you can visit this page: (http://www.caring.com/articles/do-not-resuscitate-dnr). I hope that helps. -- Emily


over 5 years ago, said...

Both my parent have been diagnoised with alzheimer's. My mother still gets herself dressed and can use the toliet. She has forgotten how to cook, doesn't clean, and doesn't know me or other close family member. My father is in the first stages with forgetting anything recent, having some outbursts, but functions pretty well. I have and am their POA for health care. As they have progressed in this disease, can I sign the DNR (do not resesutate) for them? They cannot understand it as I have brought it up before. I can't see bringing them back to what? more delusional behavior? I am a paramedic. So I know what all this means and how hard it is to recover from this.


over 5 years ago, said...

What are the alternatives if an elderly parent refuses to set up living will " my doctor knows who I am and who you are so he will know who to ask," plus, I'm only 90, my mom lived to 103 so what's the hurry?"