Advance Directives are legal documents that allow people to spell out their decisions about end-of-life care ahead of time. These documents include living wills, durable powers of attorney for healthcare, and do-not-resuscitate (DNR) orders. They give patients a way to tell their wishes to family, friends, and health care professionals and to avoid confusion later on.
Who is Eligible
Anyone over 18 years of age can prepare an advance directive.
By creating an advance directive, an individual is making her preferences about medical care known before she is faced with a serious injury or illness. An advance directive also frees an individual's loved ones from the pressure of having to make critical medical care decisions for her while they are under stress or in emotional turmoil. If an individual's health takes a turn for the worse, the advance directive provides peace of mind to know that doctors have a blueprint in place to guide them in how they treat a patient and a statement of any treatment refusal decisions a patient has previously made.
To Apply For
Patients do not need to apply for an advance directive. To prepare an advance directive, an individual or patient should contact an attorney or download a sample template, such as an Illinois Health Care Power of Attorney Form.
The living will is the oldest form of advance directive. A living will usually provide specific directives about the course of treatment that is to be followed by health care providers and caregivers. In some cases, a living will may forbid the use of various kinds of burdensome medical treatment. It may also be used to express wishes about the use or foregoing of food and water, if supplied via tubes or other medical devices. The living will is used only if the individual has become unable to give informed consent or refusal due to incapacity. A living will can be very specific or very general. An example of a statement sometimes found in a living will is: “If I suffer an incurable, irreversible illness, disease, or condition and my attending physician determines that my condition is terminal, I direct that life-sustaining measures that would serve only to prolong my dying be withheld or discontinued.”
More specific living wills may include information regarding an individual's desire for such services such as analgesia (pain relief), antibiotics, hydration, feeding, and the use of ventilators or cardiopulmonary resuscitation. However, studies have also shown that adults are more likely to complete these documents if they are written in everyday language and less focused on technical treatments.
Powers of Attorney (Health care proxies)
A health care power of attorney (or healthcare proxy) allows an individual to appoint a person they trust as their healthcare agent (or surrogate decision maker), who is authorized to make medical decisions on their behalf. Before a medical power of attorney goes into effect, a person’s physician must conclude that they are unable to make his 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 an agent can refuse a life-sustaining treatment on a patient's behalf, a second physician may have to confirm the doctor's assessment that the patient is incapable of making treatment decisions.
Do Not Resuscitate (DNRs) Orders
DNR orders are issued by healthcare professionals. An adult patient may request or consent to a DNR order orally by informing a physician, or in writing, such as a living will, if two witnesses are present. In addition, the Health Care Proxy Law allows a patient to appoint someone she trusts to make decisions about CPR and other treatments if she becomes unable to decide for herself. Before deciding about CPR, a patient should speak with her doctor about her overall health and the benefits and burdens CPR would provide. A full and early discussion between a patient and his doctor will assure that the patient's wishes will be known.