Advance medical directives: create yours now!

Advance medical directives are legal documents that allow you to plan and make your own end-of-life wishes known in the event that you are unable to communicate. They do not expire, but remain in effect until you change them, and you can easily create them yourself by using free online forms.

These directives consist of two parts: an advance health care directive (also known as a living will, or personal directive), and a medical power of attorney (also known as a health care proxy, or durable power of attorney for health care).

The advance health care directive describes your wishes regarding medical care so that your family and health care team can be guided on the appropriate medical treatment you receive. While the document is considered legal as soon as you sign it and it is notarized, it does not go into effect until such time as you are no longer able to make your own decisions. If you want to make any changes as time passes, you can create a new directive to replace the old one.

The medical power of attorney allows you to appoint a person you trust to make decisions about your medical care if you are temporarily or permanently unable to do so yourself. Typically you would also appoint a back-up person as well. This document goes into effect when  your physician declares that you are unable to make your own medical decisions. Again, if you want to make changes down the road, you can do so by creating a new medical power of attorney document.

You do not need an attorney to prepare your advance directives. However, you should ensure that the form you plan to use was specifically created for your state, as laws vary. You will need to have a witness and also get the documents notarized.

You can find advance directive forms for each state from the National Hospice and Palliative Care Organization CaringInfo website, which also provides guidance for filling out the forms. Another resource is your state’s branch of the American Medical Association.

Before you begin, educate yourself about life-sustaining treatments. The most common decisions will involve CPR (cardiopulmonary resuscitation), a DNR (do not resuscitate) order, a DNI (do not intubate) order, and artificial nutrition and hydration. You will want to be specific about when you wish to accept these treatments, specifying, for example, “only if they will help to restore my normal functions and improve my condition.”

For resources on learning more about advance directives, see the National Institute of Health's U.S. National Library of Medicine website. 

Give copies of your advance directives to anyone who might be involved with your health care. As both the original and any copies of advance directives are considered legal documents, you can distribute copies to anyone who might be involved with your health care, such as family members, friends, or clergy.  In addition, give copies to your physician and to your designated health care agent. If you enter a nursing home or hospital, have copies of your documents placed in your medical records.

There are also private services, such as MedicAlert, that will store copies of your advance directives for a fee and make them available on your behalf, which is especially helpful for those who travel.

Your advance directives remain in effect until you revoke it. If you complete  new advance directives, they invalidate the previous ones. For this reason, you should review your advance directives periodically to ensure that they still reflect your wishes.

Emergency medical technicians cannot honor advance health care directives or medical powers of attorney. Once 911 help has been called, the emergency personnel must do what is necessary to stabilize a person for transfer to the hospital. Make sure that copies of your advance directives are somewhere handy in your home so that they can accompany you to the emergency room. Only after a physician has evaluated your condition and determined the underlying conditions will your advance directives be implemented.