What are Advance Directives?
Talking about advance directives isn’t easy, but if you reach a point in life where you are unable to make your own medical decisions for any reason, having an advance directive (and having it easily accessible in case of emergency) will be critically important. Typical advance directive forms will allow you to express 1) who can make medical decisions for you if you are unable to make decisions yourself and 2) what kind of medical decisions you want them to make.
A simple step-by-step guide
Advance directives are used to record your healthcare preferences. Think of it like a personal instruction manual for important medical decisions. Your chosen healthcare decision maker, who is the person you empower to make decisions for you if you are unable to make those decisions yourself, can use the advance directive as a guidebook.
A good starting point to filling out an advance directive form is to follow these steps:
- Print out your state’s advance directive form here.
- Write down your general healthcare wishes and specify who you want as your decision maker.
- Have a conversation with your chosen decision maker. Make sure that they are comfortable making healthcare decisions for you and that they are aware of your healthcare goals, wishes, and values.
- Give a copy of the completed form to your healthcare provider and/or local hospital. This is essential, or else your doctor won’t know who your decision maker is. You can also make an electronic version of your advance directives that you can store in your phone or mobile device.
- Give a copy to each of your decision makers.
- Keep a copy for yourself.
How to express your healthcare wishes
The instructions you convey in your advance directive may depend on your current health status. If you’re young and healthy, you might write general instructions. If you’re preparing for a difficult surgery or have been diagnosed with a serious illness, you might write specific instructions.
When writing an advance directive, there can be a temptation to try to account for every hypothetical healthcare situation. Instead, consider reflecting on your values, goals, and priorities more broadly (e.g. being able to maintain independence, or being able to enjoy time with loved ones).
If you are seriously ill or are approaching the end of your life, please see our page on specific advance directives that may apply to you.
How to choose a decision maker
Your decision maker will have the power to use their best judgement to make medical decisions for you. When you’re choosing someone to be your decision maker, have a conversation with them first. Discuss your healthcare goals, values, and wishes with them. If you change your mind and want someone else to be your decision maker later, you can fill out a new form at any time.
The medical preferences you express in the advance directive are generally considered to be guidelines for your decision maker to follow, not mandatory instructions. This will protect your decision maker in case an unforeseen medical issue happens on their watch.
Depending on the state, decision makers can be called “healthcare proxies,” “healthcare agents,” or people who have “power of attorney for healthcare.”
What happens if I don’t choose someone to be my healthcare decision maker?
If you don’t choose someone to be your decision maker, then your doctor might ask your spouse or relatives to help make decisions, depending on the laws in your state. This might mean that your decision maker might not be the person you would have chosen for yourself.
If you have chosen a decision maker, your doctor will reach out to them through the information you’ve provided in the form. Many advance directives allow you to rank multiple people as decision makers, in case your doctor can’t get into contact with the first one. (It might be difficult to contact someone who lives in a different state or time zone, for example.)
Where to keep your advance directive
Once you’ve completed your advance directive form, it’s important to make multiple copies of it. You should give copies to your decision maker, your back-up decision maker, your loved ones, and your doctor. If you have an attorney, you should also send a copy to them.
It’s a good idea to keep a couple copies at home in an easy-to-reach place, just in case you ever need to quickly grab one before heading to the hospital. You might also consider storing an electronic version of your advance directive on your phone so that you always have it on hand, especially if you travel often.
Please keep the original form in a safe place that is easily accessible. (A safe deposit box might not be very accessible, for instance). You should let your loved ones and decision makers know where the original version is kept in case they ever need to find it on short notice.
How to use an advance directive
Your decision maker can’t simply tell your doctor that they are your decision maker. They will need to prove that they are your decision maker through a copy of the form. If your doctor already has a copy of the form in your medical records, they can easily check the identity of your decision maker. If your doctor doesn’t have a copy of the form, your decision maker will need to bring a copy with them.
An advance directive form is only useful if the medical personnel treating you can see the form. Otherwise, they won’t know who your decision maker is.
The Completed Life Initiative does not provide direct patient healthcare, nor does it provide legal services. We help individuals navigate their end-of-life choices with dignity and autonomy, in consultation with their clinicians and care team.