Advance Healthcare Directives: Make Your Wishes Known

You buy car insurance and homeowners insurance, but maybe you haven’t given the same attention to preparing in case you're ever unable express your healthcare wishes.

A legal document called an advance healthcare directive specifies your wishes about your care and under what circumstances you want your life prolonged. You can also name a person, called a healthcare agent or proxy, who can make care decisions for you in the event you cannot.

“Many people have thought about their wishes,” says Yvonne Chan, R.N., who manages Peninsula Circle of Care, a Mills-Peninsula Medical Center program. “But few of them put that information into an advance healthcare directive document that can be referenced in case a medical situation arises where they are unable to speak for themselves.”

Think about and document your wishes while you're healthy, Chan advises. If you suddenly fall ill or are badly injured, you may become overwhelmed with anxiety or unable to communicate what you want.

Having an advance healthcare directive will also help loved ones if they're faced with making decisions for you. “You don’t want to put your family in the position of having to guess at your wishes,” says Yvonne Chan, R.N. “Although documenting your wishes can feel overwhelming, remember that it doesn’t need to be done all at once. And you can always make changes to the document later on if needed.”

A Living Document

Serious illnesses and accidents can strike unexpectedly, so Chan recommends that everyone 18 and older complete an advance directive.

“Look at your advance healthcare directive as a living document,” Chan says. Fill out a new form any time your health changes significantly.

Since situations can arise that you didn’t anticipate, Chan says, talk about your wishes with the person you’d like to be your healthcare agent. “Then you can feel confident that he or she would be able to really, truly represent you."

You don't need to name a family member as your healthcare agent. Sometimes it’s easier to choose a friend, Chan says, because there's less chance that strong emotions will cause that person to deviate from your directive. You may also specify people you do not want to make decisions on your behalf.

• Download an advance healthcare directive form from Prepare for Your Care; it includes instructions in English, Spanish, Chinese and other languages. As long as you sign it in the presence of two witnesses or have it notarized, it is recognized as a legal document.
• Give a copy of your completed form to your primary doctor and medical facility, and keep the original for yourself. Also provide copies to your healthcare agent and to family members. Note that you may revoke or change your directive at any time.

Starting the Conversation

Think about, and even write down, what is most important to you if you become very ill. What does quality of life mean for you? If you were very sick, are there treatments that might be too much for you?

When talking with others about your directive, realize it’s a process and may take several conversations. For  tips to help you think through your wishes and talk with loved ones, see the Coalition for Compassionate Care’s helpful guides.

Medicare pays for an appointment specifically to talk with your doctor about your advance healthcare directive and related issues.

More Ways to Prepare

In addition to an advance healthcare directive, other official forms can prove helpful if you become very ill or near the end of your life.

• Do Not Resuscitate Order: This official California state document tells healthcare providers not to perform cardiopulmonary resuscitation (CPR) if your heart or breathing stops. A person with a completed DNR may wear a DNR medallion that medical personnel can easily see in an emergency. Unlike the advance healthcare directive or healthcare agent documents, this form needs your physician’s signature to be valid.
• Physician Orders for Life-Sustaining Treatment: This form is similar to a DNR order but allows seriously ill patients to specify their exact wishes for certain treatments, such as pain management, intravenous fluids and tube feeding, in addition to CPR. A physician, nurse practitioner or physician assistant must sign the form to make it valid in California. The POLST form may be used instead of, or in addition to, a DNR order.

Give copies of these forms to your doctor and any facilities where you regularly receive care, and also keep them readily available to give to emergency medical personnel.