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Comprehensive Guide to Advance Directives for Health Care


Advance directives are legal documents that allow individuals to maintain control over their health care decisions in the event that they become incapacitated. These documents are governed by laws and regulations that can differ across counties and states. There are several types of advance directives, including living wills, durable powers of attorney for health care, do not resuscitate (DNR) orders and organ and tissue donation directives. A financial advisor with estate planning expertise may be able to help you plan out your advance directives.

Types of Advance Directives

There are several types of advance directives that can go into effect in different scenarios. Here’s a breakdown of four common types:

Living Wills

A living will is a written document that outlines a person’s preferences regarding life-sustaining treatments, such as the use of a ventilator or feeding tube. They emerged in the U.S. during the 1960s as a way for people to maintain control over end-of-life medical care.

Challenges can arise when a patient’s condition is not explicitly covered by the living will or when family members question the validity or interpretation of the document. If someone doesn’t have a living will in place, the responsibility for making medical decisions often falls on their next of kin or is determined by a physician.

Durable Power of Attorney for Health Care

A durable power of attorney for health care appoints a trusted individual, such as a spouse or family member, to make medical decisions on the patient’s behalf if they become unable to do so. This person, called the health care agent, has a legal obligation to make decisions aligning with the patient’s expressed wishes or best interests.

In cases where one wants to terminate or change their health care agent, they may need to revoke the existing appointment. Then, they’ll have to create a new durable power of attorney document designating their new chosen agent.

Do Not Resuscitate (DNR) Orders

DNR orders were developed to respect patients’ desires to forgo CPR and other life-sustaining treatments in certain situations. A DNR order is a medical order given by a physician that instructs health care providers not to perform life-saving measures on a patient should they stop breathing or experience cardiac arrest. Physicians and health care providers play a key role in discussing, establishing and executing DNR orders based on the patient’s wishes, prognosis and quality of life considerations.

Organ and Tissue Donation Directives

An organ and tissue donation directive specifies whether or not a person wants to donate their organs and tissues upon death. Organ and tissue donation regulations can differ across regions. In the U.S., you can typically register as an organ donor through your state’s donor registry or your local motor vehicle office.

Why Are Advance Directives Important?

SmartAsset: Comprehensive Guide to Advance Directives for Health Care

Advance directives can help avoid conflicts between medical professionals and family members regarding healthcare decisions. And this could help ensure a person’s end-of-life wishes without the financial and emotional toll of litigation.

Benefits of Advance Directives

  • Maintain control over health care decisions: Advance directives allow individuals to make important medical choices in advance, ensuring that their preferences are respected even if they lose the ability to communicate.
  • Streamline the decision-making process for family members: By providing clear guidance on a person’s wishes, advance directives can alleviate the burden on family members who would otherwise be left to make difficult decisions on their behalf.
  • Ensure personal values are respected: Advance directives allow individuals to express their beliefs and values related to medical treatments, making certain that their choices align with their personal convictions.

Some additional benefits may include reducing health care costs, decreasing the strain on medical resources and improving the quality of end-of-life care.

Drawbacks of Advance Directives

While advance directives are recognized as legal documents, they can sometimes get challenged by differing requirements between jurisdictions, or family member and health care provider disputes. There’s also the possibility that an advance directive is misinterpreted and the wrong course of action is taken with regard to a person’s care.

How to Create an Advance Directive

These seven steps can help you establish an advance directive tailored to your needs:

  • Learn about the legal requirements for your specific region or country (U.S. states may have unique forms and rules)
  • Consider involving a legal professional, such as an elder law attorney, to help navigate the process
  • Choose an accurate and comprehensive form that covers your preferences and needs
  • Appoint a trusted health care agent if you’re creating a durable power of attorney for health care
  • Discuss your wishes with family members, your chosen health care agent and your medical providers
  • Complete the required forms and ensure they are signed and witnessed (or notarized) as necessary
  • Keep multiple copies of your advance directive and provide them to relevant parties

When to Review Advance Directives and Ensure They’re Followed

Your advance directives should be reviewed and updated upon significant life changes, such as marriage, divorce, diagnosis of a serious illness or changes in health care laws.

Options for enforcing advance directives when they are not initially followed include mediation or legal action. If family members or health care providers display resistance, it can be helpful to involve a neutral third party, such as an attorney, mediator, or trusted family member, to navigate these discussions.

Bottom Line

SmartAsset: Comprehensive Guide to Advance Directives for Health Care

Understanding the different types of advance directives, their importance, and the potential legal challenges associated with them can help individuals create a comprehensive plan for their future medical care. Advance directives often reflect a person’s values and preferences, and can help them maintain control over their health care decisions even if they become incapacitated.

Estate Planning Tips

  • A financial advisor with estate planning expertise can help you build a comprehensive plan so your assets are divided up according to your wishes. Finding a financial advisor doesn’t have to be hard. SmartAsset’s free tool matches you with up to three vetted financial advisors who serve your area, and you can interview your advisor matches at no cost to decide which one is right for you. If you’re ready to find an advisor who can help you achieve your financial goals, get started now.
  • Advance directives may just be one element of your estate plan. If you’re looking to protect your assets or ensure they’re distributed in a particular manner, consider establishing a trust. A revocable living trust can be changed while you’re still alive, but an irrevocable trust is permanent and cannot be altered once it’s established. Be sure to familiarize yourself with the various types of trusts and why they’re used.

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