Advance Directive

What is an advance directive?

An advance directive is a legal document that tells your healthcare providers and loved ones what type of medical care you want to receive if you can’t tell them yourself. The document allows you to communicate ahead of time what kinds of procedures or treatments you’d want or wouldn’t want. Advance directives also state who you’d want to make sure your requests are carried out.

Any adult can have an advance directive on file. It’s best to complete an advance directive form when you’re still healthy in case you get sick, injured or aren’t able to make decisions for yourself in the future. Making long-term healthcare plans is an important way to make sure you get the medical care you want.

Types of advance directives

Advance directive examples include:

Living will

A living will is a legal document that tells your healthcare providers what kind of medical care you’d want or wouldn’t want in an emergency. It also describes what kind of care you’d want if you were terminally ill or permanently unconscious. A living will dictates which medical treatments you’d want and which you wouldn’t. It also states under which circumstances each of your choices apply.

Durable power of attorney for healthcare

A durable power of attorney (DPA) for healthcare is a legal document that states your healthcare proxy. Your healthcare proxy is the person you’ve decided can make healthcare decisions for you in the event you’re unable to do so yourself. Your healthcare proxy is someone who should be familiar with your wishes and values. They’re also known as your surrogate, agent or representative.

You can name a DPA instead of or in addition to a living will. Another name for a DPA is a medical power of attorney (MPOA).

Physician orders for life-sustaining treatment (POLST)

A physician order for life-sustaining treatment (POLST) is a form filled out by your healthcare provider. Usually, you and your provider create a POLST together after you’ve been diagnosed with a serious illness. A POLST doesn’t replace your other advance directives, but it provides guidance about your medical care that healthcare providers can act on in the case of an emergency. Another name for a POLST is a portable medical order.

Do-not-resuscitate order

A do-not-resuscitate (DNR) order is a legal document that states you’ve opted not to have cardiopulmonary resuscitation (CPR) attempted if your heart or breathing stops. People who choose to have a DNR are usually terminally ill or have a serious medical condition. In most cases, a healthcare provider writes a DNR after discussing the risks and benefits of CPR with you and your loved ones.

Do I need an advance directive?

Advance directives aren’t just for people who are sick or very old. Illness can hit at any age, and a medical emergency could leave you without the ability to communicate your healthcare wishes. It’s a good idea to fill out an advance directive while you’re healthy and can make your decisions known. Doing so now will ensure you’ll get the medical care you want when needed. In addition, it’s helpful to name someone you trust as a healthcare proxy so you know they can communicate your wishes on your behalf if you’re not able to.

What happens if I don’t have an advance directive?

If you don’t have an advance directive and can’t make decisions for yourself, the laws in the state where you live will regulate who can make decisions on your behalf. This is usually your spouse, parents or adult children. If you don’t have any family members, some states will allow a close friend who’s familiar with your values to help make decisions.

How do I create an advance directive?

Advance directives don’t have to be complicated. They can be as simple as writing down your wishes. However, make sure to follow the laws in your state. You may wish to have a lawyer or your healthcare provider review any documents. Then, make sure to sign and have them notarized before giving copies to your healthcare providers and loved ones.

When do advance directives go into effect?

Advance directives only go into effect if you can’t communicate your medical wishes. However, it’s important to know that emergency medical technicians (EMTs) can’t honor advance directives, living wills or DPAs. They must do what’s necessary to stabilize you for transfer to a hospital. An advance directive can only be implemented after a healthcare provider at the hospital evaluates your condition and determines if you have any underlying health conditions.

Can I change my advance directive?

Yes. You may cancel or change your advance directive at any time, as long as you can think rationally and state your wishes clearly. In fact, it’s a good idea to review your advance directive periodically to make sure it still contains your most up-to-date wishes. After making changes, get the new advance directive signed and notarized, and make sure your healthcare providers and loved ones are aware of the changes.

Do advance directives expire?

Advance directives don’t expire. They remain in effect unless you make any changes to them. It’s important that you review your advance directive occasionally to ensure it still reflects your wishes. If you fill out a new advance directive, it invalidates the old one.

A note from Cleveland Clinic

Thinking about advance directives may not be pleasant, but they’re necessary to make sure your medical wishes are known in the event you can’t communicate them yourself. These can be difficult choices for you to make. But it’s important.