Types of advance directives

Turning Points 4 min read

Making end-of-life decisions can feel overwhelming, but with the correct information, you can feel better equipped to make them. Making these choices before you need to can give you the assurance that your loved ones will understand and respect the desires you have communicated if the time comes when you cannot speak for yourself.

What is an advance directive?

The National Institutes of Health (NIH) define advance directives as legal documents that provide instructions for medical care and only go into effect if you cannot communicate your wishes. Advance directives are end-of-life directives that allow you to express your wishes to family, friends, and healthcare professionals, preventing confusion later.

What is the Patient Self-Determination Act (PDSA)?

The Patient Self-Determination Act is a federal law that requires healthcare institutions (but not individual doctors) to give you a written summary of your healthcare decision-making rights and the facility’s policy concerning recognizing advance directives when you are admitted to the hospital. They will ask if you have an advance directive, but it is your responsibility to give them a copy, according to the American Bar Association. The PSDA is the law that governs different types of advance directives.

What is the most common type of advance directive?

The most common types of advance directives are the living will and the durable power of attorney for health care decisions.

Living will

A living will is an advance directive that guides your healthcare team about medical intervention preferences if you cannot make decisions. A living will is a document that can include your wishes concerning medical procedures such as resuscitation, mechanical ventilation, a feeding tube, dialysis, and organ or tissue donation. So, if there are certain treatments or procedures that you do not want, a living will instruct health care workers not to perform them.

Durable power of attorney for healthcare

A durable power of attorney for healthcare (DPOA-HC) is another type of end-of-life document that allows you to appoint a trusted person (known as a healthcare proxy or agent) to make medical decisions on your behalf if you become incapacitated. Your healthcare proxy will make decisions based on your wishes, thus upholding your healthcare preferences when you can’t communicate them yourself. Ensure that you appoint a person you can trust as they will be making life-and-death decisions on your behalf.

Provider Orders for Life-Sustaining Treatment (POLST)

POLST is a type of advance directive that translates your end-of-life wishes into medical orders. A POLST is usually for individuals with serious illnesses or frailty. It includes instructions about specific treatments you do or do not want at the end of life, such as CPR, ventilator use, a feeding tube, and hydration.

According to the American Association of Nurse Practitioners (AANP), a POLST form requires the signature of the health care provider and the patient (or their surrogate) to be a valid, portable medical order. The patient must agree to have a POLST form; a POLST is always voluntary. There is a national directory of POLST programs governed by state law.

Do-not-resuscitate (DNR) orders

A DNR order is a request not to have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. A DNR order differs from a POLST because a DNR is limited to CPR, while a POLST covers a broader scope of end-of-life treatments. The National Library of Medicine advises creating a DNR before an emergency occurs.

Planning for organ and tissue donation

Your end-of-life directives can include your organ and tissue donation wishes. Donating organs (like the heart, liver, and kidneys) or tissues (like skin, corneas, and heart valves) after death can help save or improve others’ lives. Registering as a donor is as easy as signing up online at OrganDonor.gov.

You must sign up as an organ donor with your state motor vehicle department. But perhaps more essential than taking those actions is talking with your family about your desire to be an organ donor. Ensure that your preference is in your advance directive and that your healthcare proxy is aware that you are an organ donor so that the healthcare team can honor your wishes immediately upon death.

Can family override advance directives?

Some people wonder if creating advance directives guarantees their wishes will be followed. The NIH reports that an advance directive is legally recognized but not legally binding. While your healthcare provider and proxy have agreed to honor your intentions outlined in your advance directives, there may be occasions when they don’t follow your wishes exactly. When advance directives are in place, family members who are not the healthcare proxy typically may not override the patient’s wishes.

Advance directives and end-of-life documents are essential for planning for the unpredictable aspects of life and death. Considering your intentions and completing the documents well before you need them gives you and your loved ones a clear picture of your healthcare wishes. You’ll also reduce the stress and potential conflicts in a critical situation, such as a terminal diagnosis or a tragic accident.

However, laws about advance directive types can vary by state, so it’s critical to consult with a lawyer or healthcare provider in your area to ensure your documents are valid and adequately express your wishes. AARP has developed a list of advance directive forms by state in English and Spanish.

Many people find discussing death and dying challenging. However, remember that end-of-life planning is about expressing your preferences and values and ensuring your voice will be heard even when you cannot speak for yourself. Taking the time to make these decisions today can offer you and your loved ones peace of mind tomorrow.

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