Written by Intern Jordan

The Advance Directive is a plan of procedure implemented when the patient becomes medically unavailable to make their own decisions. An advance directive can either name a substitute person

 to make decisions for the patient or detail what extent care is to be given. This legal document is written in detail, outlining the different types of life-sustaining treatments the patient would or would not accept in health care situations. These documents only go into effect when the patient is medically unable to make their own decisions. Advance Directives are characterized into two categories:

The Living Will -The Living Will is the oldest type of healthcare advance directive. A living will is a written statement that specifies what kind of healthcare the patient does or does not want to receive in the case of having a terminal illness (chronic incurable disease) or permanent unconsciousness. If there is a possibility of recovery for the patient this document will not be applicable. The Living Will may consist of the following:

  • The use of equipment such as dialysis machines and ventilators
  • Resuscitation if the patient stops breathing or the heart stops
  • Organ or tissue donation if the patient dies
  • Whether the patient would want fluids and food
  • Whether the patient wants treatment for pain, nausea and other symptoms

The Living Will can be revoked at any time, by the patient. In some states, the Living Will is nullified after a certain amount of years. Still it has limited powers, as it is only applicable when the patient is having any form of terminal illness, or they are in a vegetative state.

Medical Power of Attorney – A power of attorney for healthcare is a signed and processed document in which the patient designates an agent who can make healthcare decisions if the patient is temporarily or permanently unable to. Unlike the living will, the Medical Power of Attorney does not require the patient to have a terminal condition or be in a vegetative state.

Also known as healthcare proxy, the signer can appoint anyone as their agent. The document becomes valid only when the physician declares that the patient is unable to make medical decisions.

Importance – Between the years 1990 to 2005, Terri Schiavo was in a vegetative state. At that time, a court case was carried out from 2001 until her death in 2005, during a battle between who had medical voice over her: her parents or her husband. Without a Living Will or Medical Power Attorney, there was no written word on the prior wishes of Schiavo. With both her parents and her husband claiming to know her previous decisions, court battles carried on for over four years until the case was won by her husband.

Advance directives give the patient the right to plan their healthcare treatments for the future. Advance directives ensure that all the patients’ choices are secure, and will be available to the patient’s family and doctors, even if the patient is away from home.

For patients who sign a Do Not Resuscitate (DNR) form, death will likely become inevitable. After all, this form is a legal order written by a hospital (or on another legal form) describing the patient’s wishes to withhold cardiopulmonary resuscitation (CPR) or advanced cardiac life support (ACLS). Therefore, the loved ones can never question whether or not the patient’s wishes were followed.