Advance directive is both an umbrella term for defining and expressing how one wants to live and be treated and for state approved advance directive documents which allow you to specify those things and usually to appoint a person (healthcare power of attorney) to speak when you are unable to speak for yourself.
Other words that are used under the umbrella are living will, healthcare proxy, healthcare agent, DNR (Do Not Resuscitate), and POLST (Portable Medical Orders).
The purpose of any advance directive is to enable you to speak for yourself and to let other people know what choices you have made and what is important to you. It is a really good idea to speak with those close to you as you are preparing your advance directive. And you are only half done until you discuss and share your advance directive with others and store your document in a safe and accessible place.
While you do not need a lawyer to fill out an advance directive, your advance directive becomes legally valid as soon as you sign it in front of the required witnesses. Advance directives are legally valid throughout the United States, but the laws governing advance directives vary from state to state, so it is important to complete and sign advance directives that comply with your state’s law.
When are Advance Directives Implemented?
Emergency medical technicians cannot honor advance directives, living wills or medical powers of attorney. They can honor POLST’s and DNR orders. Absent the presentation of those documents, once emergency personnel have been called, they must do what is necessary to stabilize a person for transfer to a hospital, both from accident sites and from a home or other facility. After a physician fully evaluates the person’s condition and determines the underlying conditions, advance directives can be implemented.
What Kind of Advance Directive Do You Want?
The most useful advance directive varies by where you are in life. When you are young and healthy about all you can do is speak in general terms about your priorities.
When a person develops a chronic condition or illness, they have a clearer idea of what may happen and can be more specific about what they want. When a person has a life-limiting condition, it becomes very important to be explicit about their wishes.
Below are guides to the various stages:
- You are healthy. You want to complete an advance directive so, if something suddenly happens and you can’t speak for yourself, others will know what you want in general terms. If nothing else, COVID has taught us that unexpected things happen.
- You have a chronic condition. You also want to complete an advance directive. Because you know about your disease and its course, you can be more specific in saying what you do and don’t want.
- You have a serious illness. You also want to complete an advance directive. Because you know about your disease and its course, you can be more specific in saying what you do and don’t want. Depending on the predicted course, you may also want to complete a POLST.
- You know that you don’t have long. An advance directive may be useful as it contains more information and nuance than the POLST, but you definitely want a POLST, which is signed by a physician and specifies what treatments you want and don’t want at the end of life.
For further resources to help you think about your priorities at any stage and to help you share those priorities with others, see The Conversation Project’s Conversation Starter Guides.
Do Advance Directives Expire?
Advance directives do not expire. An advance directive remains in effect until you change it. If you complete a new advance directive, it invalidates the previous one.
You should review your advance directives periodically to ensure that they still reflect your wishes. If you want to change anything in an advance directive once you have completed it, you should complete a whole new document.
On Digital and Video Advance Directives
Don’t forget! If all these documents are just too confusing and difficult or there is not time, you can make and send a video from your phone stating your wishes, which will be helpful to those speaking for you no matter what.