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What is an Advance Directive, a Living Will, a Durable Healthcare Power of Attorney, and a Do Not Resuscitate (DNR) order?

And what do I need?

An Advance Directive (also known as a Living Will) …

… is a legal document that helps you express your desires for care and treatment if you have been declared mentally incompetent and cannot speak for yourself.   An Advance Directive usually includes specifics about end of life care and the threshold (if any) beyond which you do not want care that extends your life.   This helps providers and family members understand and respect your desires.  Learn more about how to plan for and create your state-specific Advance Directive here.

 

A Durable Healthcare Power of Attorney …

… is a document that names your Healthcare Proxy, who is someone you trust to make decisions if you have been declared mentally incompetent and are not able to make them for yourself. Most, if not all states allow the appointment of more than one Proxy in the event that your primary Proxy isn’t geographically available when needed. Depending on your state, your Proxy may also be called your Health Care Agent, Surrogate, Representative, Attorney-in-fact, or your Patient Advocate. Choose your Proxy carefully, then offer them the role, rather than assign it. Let them wait until after you’ve discussed your values, beliefs, and desires at least to the level of detail that they can accept the role only after acknowledging that it will likely be difficult.

Some criteria to consider include when choosing your Proxy:

Is your Proxy someone you can trust to make difficult decisions on your behalf during difficult emotional times and given ambiguous circumstances that you may not have explicitly discussed in advance? Your Proxy needs to be able to act on your behalf, even when their decisions are contrary to medical advice for more aggressive treatment, or contrary to the desires of other family members or loved ones. This may be by far the most important criterion. When the chips are down, this role can be very, very difficult.

Is your Proxy someone who can handle the rest of your loved ones under times of emotional duress?

Is your Proxy someone you can trust to subordinate their own values, beliefs, and opinions about treatment options to yours? This sounds simple, but it pays to discuss and mentally prepare for this. Your Proxy doesn’t need to agree with your desires, but they do need to respect and follow them.

Is your Proxy willing and able to have the difficult preparatory conversations with you about your beliefs, values, and desires when it comes to end of life treatment options?

Does your Proxy meet your state’s requirements (usually being an adult and mentally competent)?

Your Proxy may not be your attending doctor or part of your medical care team.

Given all of the above, consider that there may be advantages to choosing a Proxy that isn’t your spouse, next of kin, a child, or a parent. A close family friend, a clergy member, or a more distant relative may be less emotionally traumatized by your condition and may be better able to make treatment decisions on your behalf without creating discord amongst your other loved ones.

Some states have combined a Durable Healthcare Power of Attorney with an Advance Directive and made them one document to cover both purposes. While the terms are sometimes used inconsistently, some states call the combination above an Advance Directive, and the separate documents a Durable Healthcare Power of Attorney and a Living Will.

Some states require your Proxy to sign your document, indicating their acceptance and understanding of their role.

Some states even allow a physician to designate a surrogate or proxy if the patient hasn’t designated one for themselves. This assumes that the designated surrogate has better insights into the patient’s desires than does the attending physician.

 

A Do Not Resuscitate (DNR) order …

… is specifically to document your desires for care (or to withhold care) if your heart has stopped beating or you’ve stopped breathing. It can be a separate document covering only that, or it can be a subset of an Advance Directive/Living Will. A stand alone DNR is not nearly as comprehensive as an Advance Directive/Living Will, and is not a substitute.

 

What do you need?

Everyone over the age of 18 who has even a remote chance of being in an accident and being mentally incapacitated – that means all of us – should have a state specific Advance Directive or Living Will, and should appoint a Proxy using either a Durable Healthcare Power of Attorney or Advance Directive. Without these, you run the risk of subordinating your own desires to those of your physician or hospital if you’re not mentally competent.

 

Remember:  We coach, support, educate, and empower.  We illuminate options you may not have known you had.  But we don't decide what's right for you in your unique circumstances; only you can do that.  And we don't provide medical, financial, or legal advice; nor do we replace the valuable counsel of those who do.