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Understanding Advance Directives

You plan for the future in many ways, including career choices, financial investments, major moves, and life goals. These all have you looking years — even decades — down the line. You make decisions that will affect your future.

Your medical care decisions shouldn’t be any different.

Just as with everything else, it can be overwhelming to make decisions about healthcare. And if it’s hard enough to make those decisions for yourself, imagine how it could feel if your loved ones are ever tasked for making them for you because you’re too ill or injured to express your wishes. There could easily be confusion, tension, and decisions being made that you don’t agree with.

It can be scary to think about the end of your life — no matter what stage of life you’re in — and how it will affect your loved ones. However, it’s important to make sure medical decisions made on your behalf reflect your wishes. And that’s where advance directives come in.

These legal documents spell out your decisions about medical care before a situation arises in which you are unable to, such as a brain injury or coma. Advance directives only take effect if you are unable to communicate for yourself.

Advance directives explain your medical wishes when you are unable to, including:

  • The goals of medical treatment, such as when certain medicines should be used
  • Where you want to have treatment, such as in hospice or in a hospital
  • Which treatments you do or don’t want, such as dialysis, breathing machines, and tube feeding
  • If you want your providers to resuscitate you (revive you from unconsciousness) if your heartbeat or breathing stops
  • If you want your organs or tissue to be donated

There are a few different parts of an advance directive.

    5 Key Components of Advance Directives

  1. Living will: A document that applies while you are still living, but unable to express your wishes about medical care, and explains which treatments you do or don’t want
  2. Health care proxy: A person you name to make health decisions for you if a) you are unable to do so and b) they’re not spelled out on your living will
  3. Durable power of attorney: A document that identifies your health care proxy
  4. Do not resuscitate order (DNR): A document that tells your health care team if you want them to try to restart your heart if it stops beating
  5. Organ and tissue donation: A document in your living will or designation on your driver’s license that allows your organs, such as your heart, lungs, liver, and skin, to be transplanted to people who need them

Who May Benefit From Having Advance Directives — And Why

Advance care planning isn’t just for older people. Since you never know when something such as a car accident or life-threatening illness can occur, anyone can benefit from advance directives.

Also, if you have a medical condition such as cancer, that might require end-of-life decisions to be made, advance directives can be particularly helpful to clarify your wishes.

If you have health concerns that might influence your wellbeing in the future, such as a family history of cancer or heart attacks, you may also benefit from having these decisions spelled out.

Breaking Down Advance Directives: Questions To Consider

There are two main components to an advance directive: a living will and a durable power of attorney. You can choose to have just one or both of these legal documents.

Living Will

A living will spells out your wishes for treatment decisions, such as whether or not you would want to be hooked up to a ventilator — a machine that provides you with oxygen if you can’t breathe on your own.

When you consider these, think about your personal values and ask yourself an important question: What is more important — the amount of time you live, or your quality of life?

For example, there could come a point in your care where you wouldn’t be able to live without using a ventilator. The machine could certainly help you live longer — and you wouldn’t be able to survive without it — but it would also limit your movement and ability to eat. In that type of situation, would you prefer to use the ventilator or not?

Think about what makes life most meaningful to you — such as being able to walk or communicate with your loved ones — and ask yourself if you would be willing to give these things up.

Your living will also explains which procedures you would or wouldn’t want. You may want to include if — and under what circumstances — you would want to receive:

  • Cardiopulmonary resuscitation (CPR)
  • A ventilator to help you breathe
  • Assistance with feeding and hydration, such as tube feeding or intravenous fluids (IVs)
  • Palliative and supportive care, such as medication for pain or nausea

There is a misconception that a living will limits care by prohibiting certain treatments if you don’t clarify that you want them, but it doesn’t. You can specify treatments that you don’t want, or you can say that you don’t want to restrict any treatments at all.

Durable Power of Attorney

A durable power of attorney is a legal document that allows you to choose who you want to make medical decisions for you if you are unable to. This person is called a health care proxy, but sometimes they’re referred to as a representative, surrogate, or agent.

You can have a health care proxy in addition to, or instead of, a living will. They can make decisions about your medical care in unforeseen circumstances, such as a car accident. You may also choose to have your health care proxy evaluate each situation independently — they can evaluate any scenario and make their own decisions that they feel are best, rather than having you spell out exactly what you would want. It puts the judgment call in their hands.

Either way, this person should be familiar with your values and preferences, and you should trust them to make decisions on your behalf.

Other Health Care Documents

Other documents that address situation-specific decisions include:

  • A Do Not Resuscitate (DNR) order tells your health care team that if your heart stops beating or isn’t beating properly, you don’t want them to revive you.
  • Organ and tissue donation allow organs — such as the heart, lungs, liver, and skin — to be donated for transplant for people who need them.

Getting Started: How To Create An Advance Directive

At Stormont Vail Health, we have a social work team that is available to walk you through the process of creating an advance directive. They can assist you in understanding what you should include and how to make it legal.

As you’re considering what to include in your advance directive documents, consider who may be impacted by your choices. You may want to talk to your close family members, such as your spouse, close siblings, or adult children.

If you have a serious condition or illness, it can be helpful to talk to your health care team about some of the possible treatment scenarios you may encounter. This will allow you to spell out some of those more clearly.

After you’ve decided what to include, and chosen who — if anyone — you’d like to name as your health care proxy, the next step is to fill out the legal forms.

You can use a lawyer for this, but you don’t have to. Most states have their own advance directive forms, which are available online. Certain states may require you to have a witness when you fill them out, and others may require an official notarization. You can find a notary at your bank, post office, or local library.

Some states have public registries that are state-run where you can store your advance directive documents. This allows your providers, health care proxy, and anyone else you give permission to the ability to access your documents. There are also private firms that will store your advance directives, though these may require a fee.

If you decide to make any changes to your documents, you’ll need to replace them with updated versions. However, it’s not necessary to update them if there’s nothing you want to change. Also, if you move between states often, you may want to have a copy in each state.

What If I’ve Been Chosen as a Health Care Proxy?

If someone you love has chosen you to make important health care decisions for them when they are unable to, that means they trust you to make those decisions according to their values. It’s important that you fully understand what those values are and feel comfortable talking with your loved one about them.

Talk to them about their thoughts and beliefs. If you have specific questions, don’t hesitate to ask them. You may want to record some of their answers or videotape your conversation so you can refer back to it in the future. Remember that it may require more than one conversation to fully understand their wishes.

These conversations might be a little uncomfortable at times, but keep in mind that they chose you because they trust you.

The Benefits of Being Prepared

If you don’t have an advance directive and you become unable to make medical decisions on your own, the state where you live will choose a person to do that for you — your spouse, parents, or adult children. If you don’t have family members available, the state will choose someone they believe represents your best interests, such as a nurse or physician.

No one can predict the future. While you may never face a medical situation where you’re unable to speak for yourself, having an advance directive can provide you and your loved ones with the peace of mind that if you do, you’ll be prepared.

Why Choose Stormont Vail

Located in Topeka, Kansas, Stormont Vail Health is a community-driven organization. It offers close to home care and with limited travel requirements, it will be easier for you to get the care you need in a community you trust.

In 2018, Stormont Vail achieved Magnet designation for a third time. Magnet designation is one of the highest awards in nursing excellence and high-quality patient care. Only 9% of US hospitals have earned this recognition. The Joint Commission — with more than 50 years of accrediting hospitals in high quality standards — has also accredited Stormont Vail Hospital.

With several physicians with fellowship training in palliative care along with a specialized palliative health team consisting of clinicians, nurses, social workers, chaplains, and pharmacists in the Palliative Medicine and Supportive Care Program, Stormont Vail has an experienced and skilled medical team to help you cope with the physical and emotional pain caused by a serious illness or its treatment.

Next Steps

Make an Appointment

  • For an inpatient Palliative Medicine and Supportive Care consultation, call our outpatient clinic at (785) 354-6992 and ask for Palliative Medicine and Supportive Care.

See a Primary Care Provider

  • Call (785) 270-4440 to schedule an appointment with your Stormont Vail primary care provider.
  • Not a Stormont Vail patient? Call (785) 270-4440 to set up your first appointment with one of our primary care providers.