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Frequently Asked Questions About Advanced Directives

What are advanced directives?
What is a living will?
When does it apply?
What treatments are covered?
Who can complete a living will?
Can a living will be revoked?
What is a durable power of attorney for healthcare?
When does a durable power of attorney for healthcare take effect?
What treatments are covered?
Who can be named as an agent?
Who can complete a durable power of attorney for healthcare?
Can more than one agent be named?
Can a durable power of attorney for healthcare be revoked?
How are the living will and durable power of attorney for healthcare implemented?
What are some other differences between the durable power of attorney for healthcare and the living will?
How do health professionals know if a patient has an advanced directive?
Immunity
Do Not Resuscitate (DNR) Orders
Points to Remember


What are advanced directives?
Advanced directives are legal documents in which patients express their wishes about the kind of healthcare they want to receive should they become unable to make their own treatment decisions. There are two types of advanced directives: the living will and the power of attorney for healthcare. Check with an attorney to find out what is available in your state.

What is a living will?
A living will is a legal document in which patients are able to state in advance their desire to receive, or to withhold, life-support procedures when they are permanently unconscious or terminally ill and unable to make informed decisions.

When does it apply?
The living will applies only when two doctors determine that the patient is either in an irreversible coma or is suffering from a terminal illness and is unable to make decisions for him/herself. As long as a patient is able to make healthcare decisions, the living will cannot be used.

What treatments are covered?
The living will permits the withholding or withdrawal of any treatment that might be considered life-prolonging or that artificially extends the dying process. Some states have special provisions that allow artificial nutrition and hydration to be withheld or withdrawn when patients are in an irreversible coma.

Who can complete a living will?
Anyone over the age of 18 years who is of sound mind can complete a living will. To be legal, it must be witnessed by two adults or can be notarized.

Can a living will be revoked?
A living will can be revoked by the patient at any time and in any manner, with the patient simply tearing up the living will document, expressing orally to witnesses the desire to revoke the document, or in writing. Healthcare professionals who witness such revocations will document them in the medical record.

What is a durable power of attorney for healthcare?
The durable power of attorney for healthcare is a document that allows patients to specify in advance who should make healthcare decisions for them should they become unable to make their own health care decisions. The individual named is the agent or attorney-in-fact for the patient.

When does a durable power of attorney for healthcare take effect?
The durable power of attorney for healthcare takes effect anytime the patient loses the ability to make his or her own healthcare decisions. Unlike the living will, the patient does not need to be terminally ill or suffering from an irreversible coma.

What treatments are covered?
The durable power of attorney for healthcare document allows a patient to name an agent or attorney-in-fact with broad or specific powers to provide consent or refusal for any type of health care. Durable powers of attorney for healthcare are very flexible documents, allowing both the naming of an agent to make decisions for the patient when the patient is unable to do so, and the specification of the treatments that the patient wants or does not want to receive.

Who can be named as an agent?
Anyone over the age of 18 years can be named as the agent except for the doctor (or those employed by the doctor) who is providing care to the patient. The agent named has no legal obligation to serve and the agent is not responsible for the financial costs associated with treatment.

Who can complete a durable power of attorney for healthcare?
Any adult of sound mind may complete a durable power of attorney for healthcare. Living wills and durable powers of attorney for healthcare are often prepared without the assistance of lawyers by using standard forms. The durable power of attorney for healthcare document must be witnessed by two adults or notarized. Such documents and procedures vary by state.

Can more than one agent be named?
Only one agent can serve at a time, but other individuals can be named as successor agents if the first individual named as the agent is not able or is unwilling to serve.

Can a durable power of attorney for healthcare be revoked?
The patient can revoke a durable power of attorney for healthcare at any time and in any manner by simply tearing up the durable power of attorney for healthcare document, expressing orally to witnesses the desire to revoke the document, or in writing. Healthcare professionals who witness such revocations should document them in the medical record.

How are the living will and durable power of attorney for healthcare implemented?
Both documents require that two doctors determine that the patient has lost the capacity to make healthcare decisions. A living will has the additional requirement that the patient must be suffering from a terminal condition or is in an irreversible coma.

What are some other differences between the durable power of attorney for healthcare and the living will?
The living will simply requires the withholding or withdrawal of life-prolonging treatment whereas the durable power of attorney for healthcare names a specific agent who is authorized to make decisions for the patient. Specific instructions may be given to the agent in the durable power of attorney for healthcare, but they are not required.

How do health professionals know if a patient has an advanced directive?
Many hospitals and clinics will ask the patient or family upon admission about the existence of advanced directives when they are admitted to the hospital. The existence of an advanced directive is documented prominently in the medical chart. Also, health professionals should document the content of discussions about the patient's end-of-life desires or any expression of treatment preferences.

Immunity
Physicians and healthcare providers are immune from civil, criminal, and disciplinary action if they follow the advanced directive statute in good faith and meet its provisions.

Do Not Resuscitate (DNR) Orders
Advanced directives are not DNR orders. DNR orders are written by doctors to indicate that a patient should not be resuscitated. The order may be written to reflect a patient's or surrogate's expressed wishes about resuscitation, or because the patient will not benefit from resuscitation. For example, for someone with a living will or durable power of attorney for healthcare, CPR may be appropriate if they are suffering from an acute life-threatening condition. Patients with advance directives may want aggressive treatment for potentially reversible conditions.

Points to Remember
Advanced directives only take effect when the patient loses the ability to make his or her own decisions. Before that time, the patient's current expressed wishes should be followed.

Advanced directives do not replace active communication with patients and their families. Patients and families should be provided appropriate and sufficient information to make informed healthcare decisions. Patients' expressed preferences about healthcare treatments should be documented as they evolve in the course of treatment.

Assessing and attending to patients' spiritual needs are important in quality end-of-life care and should be a routine part of patient care.

Quality medical care also includes providing patients with a supportive atmosphere in which to reflect on end-of-life choices and to allow their wishes to be communicated to their healthcare providers and to their families.


ADVANCED DIRECTIVES