A healthcare directive is a legal document that describes a person’s wishes regarding medical treatment in the event they become unable to communicate or make decisions for themselves. It is one of the most important documents in any estate plan and yet one of the most commonly overlooked.
Having a healthcare directive in place ensures that your medical wishes are known and legally documented so that doctors and family members can honor them even when you cannot speak for yourself.
Types of healthcare directives
The term healthcare directive is an umbrella term that covers several related documents. The two most common are the living will and the healthcare power of attorney.
- Living will — a written document that describes the types of medical treatment you do or do not want under specific circumstances such as terminal illness, permanent unconsciousness, or end stage disease. It speaks for you when you cannot speak for yourself.
- Healthcare power of attorney — also called a medical power of attorney or healthcare proxy, this document names a person you trust to make medical decisions on your behalf if you are unable to do so. The person you name is called your healthcare agent or healthcare proxy.
Some states combine both documents into a single form called an advance directive or advance healthcare directive. The terminology varies by state but the purpose is the same.
What a living will covers
A living will allows you to document your wishes regarding specific medical interventions including:
- Cardiopulmonary resuscitation — whether you want CPR performed if your heart stops
- Mechanical ventilation — whether you want a machine to breathe for you if you cannot breathe on your own
- Artificial nutrition and hydration — whether you want a feeding tube if you cannot eat or drink on your own
- Dialysis — whether you want kidney dialysis if your kidneys fail
- Comfort care and pain management — your wishes regarding palliative care and pain relief
- Organ and tissue donation — whether you wish to donate organs or tissue after death
A living will only takes effect when you are unable to make or communicate your own decisions. As long as you are conscious and able to communicate you retain full control of your medical decisions regardless of what your living will says.
What a healthcare power of attorney covers
A healthcare power of attorney gives your designated agent the authority to make medical decisions on your behalf when you are unable to do so. This can include decisions about:
- Consenting to or refusing medical treatment
- Choosing doctors, hospitals, and care facilities
- Accessing your medical records
- Decisions about surgery, medication, and other procedures
- End of life care decisions if not already addressed in a living will
Choosing the right healthcare agent is one of the most important decisions you will make when creating a healthcare directive. Your agent should be someone you trust completely, who understands your values and wishes, and who is willing and able to advocate on your behalf in stressful medical situations.
Why both documents are recommended
A living will and a healthcare power of attorney complement each other. A living will documents your specific wishes but cannot anticipate every possible medical situation. A healthcare power of attorney gives your agent the flexibility to make decisions in situations your living will may not address.
Having both documents together provides the most comprehensive protection. Many estate planning attorneys recommend completing both at the same time.
When a healthcare directive takes effect
A healthcare directive typically takes effect when a physician determines that you are no longer able to make or communicate your own medical decisions. This might occur due to:
- Unconsciousness following an accident or medical emergency
- Advanced dementia or other cognitive decline
- Terminal illness that has progressed to a point where you can no longer communicate
- Any other condition that renders you unable to make informed decisions
How to create a healthcare directive
Requirements vary by state but generally include:
- The person creating the directive must be at least 18 years old and of sound mind
- The document must be signed by the person creating it
- The signature must be witnessed by at least two adults in most states
- Many states require notarization
- Some states have specific official forms that are recommended or required
Many states provide free official forms for healthcare directives through their department of health or state bar association websites. National organizations such as CaringInfo — a program of the National Hospice and Palliative Care Organization — also provide free state specific forms at caringinfo.org.
Where to keep your healthcare directive
Once completed your healthcare directive should be:
- Kept in a safe but accessible location at home — not in a safe deposit box where it cannot be accessed in an emergency
- Given to your healthcare agent
- Given to your primary care physician and any specialists to be placed in your medical records
- Provided to any hospital or care facility where you receive treatment
- Registered with your state’s healthcare directive registry if your state has one
Updating your healthcare directive
A healthcare directive can be updated or revoked at any time as long as you are mentally competent. It is a good idea to review your directive periodically — especially after a major health diagnosis, a change in your personal relationships, or a change in your wishes. Make sure your healthcare agent is aware of any changes.
Having the conversation
Creating a healthcare directive is only part of the process. It is equally important to have a conversation with your healthcare agent and family members about your wishes. Documents alone cannot replace the clarity that comes from a direct conversation about your values and priorities regarding medical care.
Key terms to know
- Healthcare directive — an umbrella term for documents that describe medical treatment wishes and designate a healthcare decision maker
- Living will — a document describing specific medical treatment wishes
- Healthcare power of attorney — a document naming a person to make medical decisions on your behalf
- Healthcare agent or proxy — the person named to make medical decisions under a healthcare power of attorney
- Advance directive — another term for healthcare directive used in many states
- Palliative care — medical care focused on relieving symptoms and improving quality of life rather than curing disease
- DNR order — do not resuscitate order, a medical order that instructs healthcare providers not to perform CPR
Sources
- National Institute on Aging — Advance Care Planning
- CaringInfo — National Hospice and Palliative Care Organization — caringinfo.org
- USA.gov — Estate Planning
- American Bar Association — Public Resources
This article is for general informational purposes only and does not constitute legal or medical advice. Laws vary by state. Consult a licensed attorney or healthcare provider for guidance specific to your situation.