5 Things To Know About Advance Directives

If you become too sick to make your own health care decisions, advance directives can help do it for you. Advance directives are legally binding documents that spell out what medical care you want and who will guard those choices for you. These papers help to avoid confusion by conveying your wishes to loved ones and clinicians in case illness or injury makes you unable to communicate.

There’s no need to wait for retirement or your golden years to set up advance directives. In fact, any competent adult who is age 18 or older, has been married or is a parent can complete and sign them. To begin, talk to your doctor about possible medical situations that may affect you and the decisions they may require. Invite open conversation with loved ones about your wishes and the advance directives you put into place.

Here are five things to get you started.

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1. Complete a health care proxy form

A health care proxy form designates one person to make medical decisions on your behalf if you can no longer speak for yourself. This individual will be your voice and make choices according to your preferences or best interests. The person you appoint is a health care agent (or health care proxy). Everyone older than 18 should appoint a health care agent, according to the New York State Department of Health. If you don’t, spouses or next of kin (if unmarried) can make decisions about your care, but there are often conflicts when you’re single and have more than one sibling or multiple children.

2. Establish a living will for hospital care

A living will details your wishes about end-of-life medical care. It provides directions for your doctors and health care agent about the treatments, life-prolonging procedures and other medical interventions you want (or don’t want).

3. Use MOLST to cover sub-acute care

Unlike living wills, the MOLST (Medical Orders for Life-Sustaining Treatment) form provides directions that nursing home personnel and emergency medical technicians (EMTs) can put into practice without a physician sign-off. That’s important when someone loses decision-making capacity at home, a nursing home or hospice, or must be transferred to another hospital.

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4. Know the rules of advance directives

Their terms never expire, but advance directives are not written in stone. Signing these “living documents” is voluntary and you can update them as necessary, according to the National Institute on Aging. You don’t need an attorney to complete any of the forms, although it’s fine to use one.

Advance directives have no expiration date, so review them every five or 10 years and revise them if your situation or your health changes. All you need to do is tear up the old one, sign a written revocation (cancellation) or update your specifications on a new form.

Laws vary between states, so be sure you complete and sign the papers that are right for where you live. CaringInfo provides advance directives that are legal in all 50 states, Washington DC and Puerto Rico along with additional resources and advice.

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5. Share copies with your doctor and loved ones

Give copies to your health care agent and tell those closest to you where your advance directives are. Give copies to your doctor and bring a copy with you if you go to the hospital so the advance directives become part of your medical record. And keep track of anyone who has copies in case you decide to change the forms, the New York State Department of Health advises.

Written by Samuel Packer, MD. Dr. Packer is chief of the Northwell Health Division of Medical Ethics and chair of the ethics committees at North Shore University Hospital, Long Island Jewish Medical Center and Cohen Children’s Medical Center. He also serves as the Robert and Florence Kaufman Professor of Medical Ethics at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and codirects the Hofstra University Bioethics Center.

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