Advance Medical Directives: Questions and Answers
What is an Advance Medical Directive?
An advance medical directive is an important document for any person to prepare while they are still able to make decisions for themselves regarding medical care decision-making. It is governed by state law in the United States. Statutes and regulations differ from state to state, and each state may suggest a specific form for use, but the underlying principals remain the same.
The person executing an advance medical directive does so through a signed, notarized document, in which that person chooses a health care representative to speak for them if and when they become too sick to speak for themselves. Stated another way, you can request a loved one to be your voice and to make health care decisions for you when you are unable to do so. This is also known as a health care "proxy." Through the directive/proxy, your representative has the same rights to request or refuse treatment that you would have when and if you become incapable of making and communicating decisions.
Although I have type 1 diabetes and am a cancer survivor, my advance medical directive also may come into play if I am in a serious car accident or suffer some other grave injury or illness that results in my going into a coma or otherwise deprives me of consciousness or the capacity to make decisions with a sound mind. For this reason, an advance medical directive is not a document reserved only for the elderly or health compromised individuals. Women of childbearing age often prepare advance directives prior to childbirth. Other people ensure they have this documentation in place in advance of any routine surgery or screening.
Preparing and executing an advance medical directive can ensure not only that your desires regarding health care decisions are expressed and followed, but that certain persons are (or in some cases are expressly not) permitted to speak on your behalf. You can have peace of mind that you have documented clear guidance for medical professionals as to what measures you wish to be taken, which ones you do not wish, your religious beliefs and any other considerations. An advance medical directive ideally should be prepared when you are relatively well, not under stress of a serious medical diagnosis or accident and without pressure from loved ones as to their own, personal beliefs regarding your treatment. A clear mind can better ensure that you think through everything you wish to be expressed with respect to your health care.
Doctors often have these forms available to patients prior to surgery or other involved treatments, but it is best to prepare an advance directive well before it may be needed.
Control Health Care Decisions With an Advance Medical Directive
Advance Medical Directive Questions and Answers: Part 1
1. Do I have to complete an advance medical directive for surgery or other medical treatment?
No. Your medical professional may not require you to sign an advance medical directive as a condition of treatment. They may have forms available, and may encourage you to identify a health care representative with whom they may communicate, as well as establish your treatment wishes, which may help the doctor make difficult decisions. Be sure that, if you do wish to complete a form at a hospital, it is properly witnessed as required by state law and signed by the person to whom you are assigning rights to make treatment decisions, so that it is effective.
2. Who prepares an advance medical directive?
While any person may find and fill out a form found online, it is highly recommended that both your medical professional and an attorney be consulted. A doctor can answer medical questions regarding complications that may result from certain procedures or treatments and quality of life thereafter. An attorney can address any legal concerns regarding the competency of the person executing an advance directive, the persons selected as health care representatives, and can help ensure that all aspects of a desired health care plan are addressed. They can also arrange for the advance medical directive to be executed properly so that it is enforceable.
3. Who can execute an advance medical directive?
Any person that is legally capable of executing a contract may execute an advance medical directive. This is known as "competence," and generally includes persons of legal age (18 years or older in the United States), of sound mind who is able to appreciate and understand the consequences of his or her decision. A person who is unconscious may not execute an advance medical directive. In some cases, a person who is under undue influence (stress, family pressure, etc.) may not be able to execute a valid and binding advance directive. You may not execute an advance medical directive for any person other than yourself.
Sample Advance Medical Directive Excerpts (State of Oregon)
The Mayo Clinic on Advance Medical Directives
Advance Medical Directive Questions and Answers: Part 2
4. What if my health improves and I want to change my mind about my advance medical directive?
You may revoke an advance directive at any time, provided you are competent to make such a decision. "Competence" is a legal term that generally means that the person is of sound mind and is aware of and can appreciate the consequences of his or her decision-making. The manner of advance medical directive revocation is usually prescribed by state law. In Oregon, revocation may be completed in any manner that expresses your desire to revoke it. As an attorney, I recommend advance directive revocation to be in writing and witnessed and/or notarized, if possible.
5. What if I don't prepare an advance medical directive before I need treatment?
The answer varies from state to state. In Oregon, state law requires that life-sustaining procedures that would otherwise be applied to a principal who is incapable and who does not have an appointed health care representative or applicable valid advance directive may be withheld or withdrawn if the patient has been medically confirmed to be in a terminal condition, permanently unconscious, in a condition in which administration of life-sustaining procedures would not benefit the patient's medical condition and would cause permanent and severe pain; or in an advanced stage of a progressive illness that will be fatal, and the patient is consistently and permanently unable to communicate by any means, to swallow food and water safely, to care for the patient's self and to recognize the patient's family and other people, and it is very unlikely that the principal’s condition will substantially improve. If any of these conditions exist, the medical professional will look to the patient's spouse, a majority of the patient's adult children if they can be located, either parent of the patient, if available, or an adult relative or family friend, in that order.
6. How long does an advance medical directive last?
An advance medical directive is valid as long as it is properly executed, witnessed and the assigned health care representatives sign the form to indicate their acceptance of the assignment. If you already have an advance directive, be aware that governing laws may have changed and new forms may be required. Legal guidance may assist you in this regard.
7. Who should keep a copy of my advance medical directive?
You should retain an original of your advance medical directive with other important papers at home or in a security deposit box. Make copies to provide to your doctor, your health care representative and loved ones. If you have an attorney, make sure that he or she has a copy, as well.
7. What should be included in an advance medical directive?
In Oregon, the advance directive form allows you to select whether your health care representative must follow your instructions or whether your instructions are guidelines to consider when making decisions about your care. The form also includes specific directions regarding end of life care, specifically close to death, permanently unconscious, advanced progressive illness and extraordinary suffering. You may select whether to request or decline life support and tube feeding. There is an option for additional instructions to be included, which may be as varied as requesting - or prohibiting - resuscitation, certain pain medications, certain religious practices, etc.
How Does an Advance Medical Directive Differ from a Living Will?
An advance medical directive differs from a living will and is generally less detailed. A living will often includes the individual's specific wishes regarding services such as:
- analgesia (pain relief),
- artificial (intravenous or IV) hydration,
- artificial feeding (feeding tube),
- CPR (cardiopulmonary resuscitation)
- life-support equipment including ventilators (breathing machines),
- do not resuscitate (DNR).
On the other hand, you may not need both an advance medical directive and a living will, if you include a document in addition to the directive form that details your wishes specifically on each of the above items.
Poll: Do You Have an Advance Medical Directive?
Do You Have an Advance Medical Directive?
Final Comments on Advance Medical Directives
This article is provided as general guidance and should not be relied upon as legal or medical advice. Before you or a loved one prepares an advance medical directive, specific governmental laws and regulations governing your state or country should be reviewed and discussed with a third party, ideally someone other than your treating physician.
If you feel pressured or uncomfortable about any aspect of a form advance directive, persons that are volunteering to serve as a health care representative, or the treatment you are planning to undergo, this is your time to speak up and make your desires known. Be sure to include any additional values, beliefs and directions regarding your medical care in an attached document to the advance medical directive, along with a properly witnessed signature to ensure its effectiveness.
This article is accurate and true to the best of the author’s knowledge. Content is for informational or entertainment purposes only and does not substitute for personal counsel or professional advice in business, financial, legal, or technical matters.
© 2020 Stephanie Marshall