Fast Fact: Advance Directive Q & A
by Center for Personal Finance editors
What is an advance directive?
An advance directive refers to the written instructions for the kind of medical care you would want if you become unable to make those decisions yourself. Laws about advance directives vary across states. Common forms of advance directives include a living will and a durable power of attorney for health care. It's important to understand that an advance directive is not the same thing as a will.
What is a living will?
A living will states in detail what care you would--and would not--want if you couldn't express your wishes. It comes into effect when you, as determined by physicians, are terminally ill, faced with a life-threatening situation, or in a persistent vegetative state--commonly referred to as a coma.
What is a durable power of attorney for health care?
This legal document names the person you appoint to make health-care decisions for you. Also referred to as a patient advocate or a health-care surrogate, the person may not be a minor and must be willing to serve. You may choose a family member, friend, or anyone else you trust. If you want the advocate to refuse treatment and let you die, you must say so specifically in the document. This document comes into effect only when you're not able to make health-care decisions for yourself.
How can I write an advance directive?
Advance directives don't have to be complicated legal documents. You can complete a short, usually simple form about what you want done or not done if you become incapacitated. You can use a general form provided by your physician, your health department, or your state department on aging. You can talk to a lawyer, particularly if you live in more than one state during the course of a year or if you don't fully understand the standard forms. Or, you can use a computer software package for legal documents that's compliant for your state.
Can I include specific wishes on the forms?
Yes. It's best to be as specific as possible. For example, you may want to state that you don't want your heart restarted. You may not want to go on a breathing machine or ventilator. You may want your physician to try aggressive--and potentially uncomfortable--treatment for a while, but specify that it be stopped if your condition doesn't improve.
What happens if I don't fill out any advance directive forms?
Your doctor may have to provide medical treatment within the limits of the law, which may not be what you want. Your family members may be deeply divided over what they think you would want.
Could HIPAA provisions prevent the patient advocate from receiving medical information about me?
Maybe. To make sure privacy provisions in the Health Insurance Portability and Accountability Act (HIPAA) don't keep the people named in your advance directives from receiving medical information about you, add a clause to your durable power of attorney for health care and living will forms stating that your agent has authority to receive information under HIPAA.
Where can I find the forms?
Forms are available from physicians, hospitals, attorneys, and several Web sites. Consumers Union recommends Five Wishes, a form from Aging With Dignity, a national nonprofit group in Tallahassee, Fla. ($5), as well as the American Bar Association's free workbook "Tool Kit for Health Care Advance Planning".
Can I change my advance directive?
Yes. You can change the forms at any time, as long as you're considered of sound mind. That means you're still able to think rationally and communicate your wishes in a clear manner. Make sure the changes you make are signed, dated, and notarized or witnessed, if required by your state laws.
Who should have a copy of the forms?
Give copies of the forms to your patient advocate or health-care surrogate, physicians, hospital, family members, clergy--anyone who has an interest in your medical treatment. You may wish to keep copies online. The U.S. Living Will Registry will store it at no charge.
October 31, 2005
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