Understanding Advance Directives and End-of-Life Medical Decisions

It is one of the most difficult things we will ever have to do in life to contemplate our own death. Yet it is very important to think carefully about the medical treatment we would want for that challenging time. Medical technology can now keep us alive long after we have ceased to enjoy meaningful quality of life.

Planning ahead through estate planning and creating legal documents such as advance directives can help ensure your wishes are understood if you can no longer communicate them yourself.

Key Takeaways About Advance Directives

• An advance directive explains your wishes for medical treatment if you cannot communicate them yourself.
• A healthcare agent or proxy can help make decisions on your behalf.
• Conversations with your loved ones are just as important as the legal document itself.
• Your advance directive should be reviewed regularly as your circumstances and wishes change.
• An estate planning attorney can help ensure your documents meet legal requirements.

What Is an Advance Directive?

A series of legal rulings around thirty years ago established the rights of patients to decide when life support should be stopped. The fear of being kept alive indefinitely by artificial means led many people to create legal documents known as advance directives.

An advance directive expresses your wishes about the kind of medical treatment you would prefer. It is called “advance,” meaning ahead of time; and “directive,” meaning your directions about whether you want medical providers to keep you alive at all costs, or whether you would prefer to pass naturally when life becomes no longer meaningful.

It is wise to think about these decisions and create such a document well before you face the end of life.

An advance directive is often included as part of a broader estate plan, alongside documents such as a power of attorney and will.

Do Advance Directives Always Work as Intended?

After thirty years, concerns have now shifted to assess whether advance directives really do serve the purpose for which they are intended. Do advance directives really ensure that we receive the treatment we would like?

The short answer is “yes but.”

Yes, because it is just as important now to create a legal document by which to appoint a person to help communicate your wishes. The “but” part comes in with the issues raised below.

The Importance of Choosing a Healthcare Agent or Proxy

The answer to these issues is the same as it has always been: establish a close relationship with one or two people – called “agents” or “proxies” – whom you appoint to step in when you can no longer make healthcare decisions for yourself.

You should talk with your agents so they understand, in as much depth as possible, where you stand on end-of-life questions and medical treatment decisions.

Over the years, we have learned that advance directives might not work as well as they could. Several concerns have emerged:

Common Concerns With Advance Directives

1. Medical situations are difficult to predict

• It is unrealistic to micro-manage healthcare decisions in advance.
• There are many variables that depend on the particular medical situation.
• Treating a complicated illness often requires input from multiple specialists.
• A legal document created years earlier may not address every possible medical circumstance.

Treating a complicated illness has been likened to a jigsaw puzzle, where each puzzle piece could fit multiple other pieces. The right fit for each piece must often be determined by a team of specialists who review the circumstances and collaborate on treatment decisions.

2. Standard forms may not provide enough detail

The “check-the-boxes” approach taken by many “fill-in-the-blank” forms is too limited to be helpful except in the most general ways.

Without additional detail, these documents may not adequately address the unique circumstances and decisions that can arise.

3. People’s wishes can change over time

Change is constant and humans are adaptable. It is one thing to imagine, when in good health, that life would not be worth living if you became permanently bedridden.

However, when a person is actually in that situation, they may find new meaning and value in life. Choices made years earlier may look different when facing the reality of a medical condition.

4. Medical circumstances and prognoses can change

A medical prognosis can change over time. A condition that once appeared hopeless may have different treatment options available as technology, research, and medical knowledge continue to improve.

This means decisions made years earlier may not always reflect the circumstances a person faces in the future. Healthcare providers must consider the patient’s current condition, available treatments, and overall wishes when making decisions.

5. Documents must remain accessible

• Advance directives should remain readily available at your home.
• Your healthcare agent or proxy should have a copy.
• Your documents should not be hidden away or forgotten when they are needed.

Why Conversations Matter Alongside Legal Documents

The best alternative is to create an effective, current, and available legal document backed up by serious conversations between the patient and the agent or proxy.

A document that meets legal requirements is essential, but beyond that: conversation in advance is the crucial additional element.

Discussing Your End-of-Life Wishes

The conversation should occur first between the patient and their agent or proxy. They should discuss quality-of-life issues and what matters most to the patient.

The discussion should avoid excessive detail about hypothetical situations that may never occur. Instead, the goal should be to provide agents or proxies with enough information to respond appropriately to unforeseen circumstances.

Helpful resources to assist with these conversations include:

• The Conversation Project
• The Centers for Disease Control and Prevention

What Happens If You Cannot Make Medical Decisions Yourself?

If the time comes when you cannot speak or make decisions, your agent will be best equipped to communicate your wishes to medical providers.

Knowing your wishes in advance allows your agent to focus on ensuring providers have the information needed to make difficult decisions based on the facts as they exist at that time.

What If You Do Not Have Someone to Act as Your Agent?

What if you are alone and do not have someone whom you trust to act as your agent?

First, study the guidance resources provided in this article. Then contact us to create a legally effective advance directive document that clearly explains your wishes.

The final step would be to schedule an appointment with your doctor to discuss your wishes and provide them with a copy of your document.

Keep Your Advance Directive Available

• Make sure doctors and agents have copies ready for use.
• Keep your documents stored somewhere accessible.
• Carry a wallet card that informs healthcare providers whom to contact during an emergency.

You can print a wallet card here:

American Hospital Association wallet card

Create an Advance Directive With an Estate Planning Attorney

There are no assurances in this life, except that it will end for us all. The hope is that we will have delegated people whom we trust to step in when we need them – and that we will have talked with them about the kind of care we want to prepare for a passing that is as peaceful and merciful as it can be.

If you are looking for an estate planning attorney in the Mount Dora, Florida area, please give us a call or drop us a line! We look forward to hearing from you!

Frequently Asked Questions About Advance Directives

What is the purpose of an advance directive?

An advance directive allows you to document your healthcare preferences and explain what medical treatments you would or would not want if you become unable to communicate your decisions.

Is an advance directive the same as a living will?

A living will is one type of advance directive that outlines your wishes regarding certain medical treatments. An advance directive may also include appointing a healthcare agent to make decisions on your behalf.

Why should I discuss my wishes with my family?

A conversation with your chosen healthcare agent helps them understand your values and preferences. This allows them to make informed decisions if unexpected medical situations arise.

When should I create an advance directive?

You should create an advance directive before a medical emergency occurs. Planning ahead ensures your wishes are documented and available when they are needed most.