Advance Directives

An advance directive or living will allows you to document your wishes concerning medical treatments at the end of life.

Before your advance directive can guide medical decision-making, two physicians must certify:

• You are unable to make medical decisions,
• You are in the medical condition specified in the state's living will law (such as "terminal illness" or "permanent unconsciousness"),
• Other requirements also may apply, depending upon the state.
  

A medical power of attorney (or healthcare proxy) allows you to appoint a person you trust as your healthcare agent (or surrogate decision maker), who is authorized to make medical decisions on your behalf.

Before a medical power of attorney goes into effect a person’s physician must conclude that they are unable to make their own medical decisions. In addition:

• If a person regains the ability to make decisions, the agent cannot continue to act on the person's behalf.
• Many states have additional requirements that apply only to decisions about life-sustaining medical treatments.
• For example, before your agent can refuse a life-sustaining treatment on your behalf, a second physician may have to confirm your doctor's assessment that you are incapable of making treatment decisions.

• Advance directives are legally valid throughout the United States. While you do not need a lawyer to fill out an advance directive, your advance directive becomes legally valid as soon as you sign them in front of the required witnesses. The laws governing advance directives vary from state to state, so it is important to complete and sign advance directives that comply with your state's law.
• In the state of California, if you are in a Skilled Nursing Facility when completing an Advance Directive, a patient advocate or ombudsman (as may be designated by the Department of Aging for this purpose) must sign as a witness, either as one of the two witnesses or in addition to notarization. Cal Probate Code §§4675(a)(West 2004).
• Emergency medical technicians cannot honor living wills or medical powers of attorney. Once emergency personnel have been called, they must do what is necessary to stabilize a person for transfer to a hospital, both from accident sites and from a home or other facility. After a physician fully evaluates the person's condition and determines the underlying conditions, advance directives can be implemented.
• One state’s advance directive does not always work in another state. Some states do honor advance directives from another state; others will honor out-of-state advance directives as long as they are similar to the state's own law; and some states do not have an answer to this question. The best solution is if you spend a significant amount of time in more than one state, you should complete the advance directives for all the states you spend a significant amount of time in.
• Advance directives do not expire. An advance directive remains in effect until you change it. If you complete a new advance directive, it invalidates the previous one.
• You should review your advance directives periodically to ensure that they still reflect your wishes. If you want to change anything in an advance directive once you have completed it, you should complete a whole new document.

Source: Caring Connections, a program of the National Hospice and Palliative Care Organization (NHPCO).