An Advance Directive is legally and ethically binding, meaning that the principal’s wishes must be respected and carried out by your chosen stand-in-decision maker, doctors, and any other healthcare professionals if the need arises. The document is implemented if and only if the principal is unable to make decisions for themselves.
EXAMPLE
Patients with dementia, Alzheimer’s, etc.
In other words:
An advance directive is a document is used by individuals (principals) to outline their medical and end-of-life treatment wishes and to designate someone to make medical decisions on their behalf when they become terminally ill or severely injured.
Other than that, if one is incapacitated, family members would have to obtain guardianship rights from a local court to implement the directive. However, more often than not, hospitals will, by default, allow a spouse or close family member to stand in as the agent. However, this is dependent on the local and state laws that apply.
What Does the Advance Directive Form Include?
An Advance Directive replaces four separate documents that are used to give predetermined directives or transfer decision-making authority.
These documents are:
- Medical Power of Attorney: This allows you (the principal) to permit someone (health care agent) to make medical/healthcare decisions on your behalf if you become terminally ill or incapacitated and cannot communicate your wishes.
- Living Will: Used by individuals to outline the type of medical wishes/treatments they would and would not want to receive should consider a situation where they cannot communicate this arises—also referred to as a treatment directive.
- Physician Orders for Life-Sustaining Treatment (POLST)
- Do Not Resuscitate Order (DNR).
As a collective of these documents, an advance directive form smoothens the entire process for the patient and medical staff. Family members are usually the go-to stand-in-decision makers. Still, if this is not an option, you can appoint your physician or lawyer as your decision-maker.
How to Change Requirements In the Advance Directive?
As the principal, you are allowed to make changes to an existing Directive at your convenience. You can simply fill out new forms and get rid of the existing directive and repeat the registering process. Alternatively, you can inform your agent, doctor, or lawyer of the change. Once altered or written a new, issue everyone an updated copy. Avoid just crossing out or adding new information on an existing directive unless you change your contact information (address or phone number).
Steps to Get an Advance Directive
If you have contemplated on coming up with an Advance Directive but do not know where to start.
We shall look into consecutive steps you can follow to get one:
Selection of an agent
The first step should be to select an agent (stand-in-decision maker) to make healthcare decisions for you. This is often termed as the medical power of attorney section. The agent can only act if you (the principal) are incapacitated. Their decisions should be with the principal’s best interests in mind. As a result, it is advocated that you select a competent and willing agent-someone trustworthy.
Additionally, the principal can choose a second agent to step in should the first agent be unable or unavailable to make decisions. However, the decision-making powers cannot be shared by the two agents at any one time.
Outline the powers
The following step should be to determine how much power/authority one is willing to hand over to the agent. An agent’s powers vary from one situation to another, and as a result, specificity is critical.
An agent’s powers can be:
- Deciding to keep the principal as long as possible even without the possibility of recovery
- Carrying out post-death responsibilities such as autopsy, ensuring the principal’s remains are kept where they wanted, etc.
- If the principal wishes to assign the attorney-in-fact other responsibilities/power/authorizations, they can do so.
You should also determine when you want this directive to become effective; immediately or upon incapacitation.
End-of-life options
After assigning the agent powers, you should include how you wish to be handled to get to an incurable state. This section is reflective of a living will. Under this section, a principal can direct medical personnel not to perform life support assistance procedures such as breathing machines, feeding intravenously, etc.
TIP
One can include a Do Not Resuscitate (D.N.R.) in the form
The Form is used to prohibit medical personnel from performing C.P.R. or any other life-saving procedures if the principal stops breathing or their heart stops.
Signatures
The next step is the signing to validate the document. Signing requirements are governed by the principal’s state of residency laws. An Advance Directive, as a requirement, must be signed by the principal, notary public, two witnesses, or both. You can choose to notarize the document.
Register the directive
Once all parties have signed, it is customary to register it to a State Registry or any other National Organization. This directive can also be stored in an easily accessible place and its location is outlined in a wallet card.
Filling an Advance Directive Form
Whenever you come up with this form, you want to communicate exactly what you wish effectively. With this in mind, as a principal, it is imperative to state that an excellent advance directive is as effective as how well it was written. Therefore, it is essential to get it right at this stage.
It comprises several sections.
Medical power of attorney
This is the first section of the directive and has sub-categories addressed below:
Power of attorney status
This section outlines whether the principal wishes to use a medical power of attorney or not. You can indicate how you wish to proceed accordingly. This section allows the principal or declarant to declare if they would like to utilize a medical power of attorney or not. How they wish to proceed they can make it clear by indicating it at this point.
Principal information
The next step is to outline your personal information. This information is essential to point out who the principal is clearly.
It is done by stating the following:
- Principal name: This is the official name of the principal as used in other official documents such as health care records.
- Principal Address: The principal’s address information then follows up the name. It is given by declaring the street name, city, state, and zip code. Information provided here should match that given to your doctor or representatives.
Medical attorney in-fact information
This next item should be the agent’s information. It is important to identify exactly who is being tasked with the responsibilities outlined in the advance directive. This is the person who Medical Personnel will seek answers about your medical preferences in a situation you cannot communicate (i.e. speaking, smiling, blinking) their preferences.
- Attorney-in-fact name: The agent’s official name should appear as it does in other formal documents such as an identification card. It is meant to specifically identify who will be in charge of directing medical personnel when treating an incapacitated principal. Where there is an alternate agent, their name should be provided in this section. This is in the event that the primary agent is unavailable; the alternate agent can assume the responsibilities.
- Attorney-in-fact address: The agent’s address information should be presented in the following format; street address, city, state, and zip code.
- Attorney-in-fact phone number: The following item should be the agent’s phone number. This should be their personal phone number; however, their work number can be included. Phone number is important in case there is an emergency medical personnel can be able to reach the agent the earliest possible.
Alternate agent information
As earlier mentioned in the article, you can choose to include a second agent as a precaution or any other reason ranging from the agent-in-fact’s revocation to him/her being incapacitated. If this is the case, you include their details at this point in the Advance Directive.
The information should appear in a statement in the order below:
- Alternate agent name
- Alternate agent address
- Alternate Agent Phone
Living will
This is the second section of an Advance Directive form. It addresses the end-of-life treatment preferences you would or would not like performed on you.
Living will status
It should outline the principal’s directives and preferences in writing by issuing a living will. This section can be completed regardless of whether an attorney-in-fact was named previously in the document. It can also be left intentionally blank. Other directions can be added.
This might be in terms of:
- During life support, the quality of life you would or would not like should be communicated, for instance, chronic coma, inability to communicate, inability to recognize loved ones, total dependence on basic care, and other principal concerns.
- Intravenous food and water- Include a statement directing whether consent should be sought before such measures are undertaken.
- Specific life-sustaining treatments such as C.P.R., ventilation, feeding tube, dialysis, etc., should be handled.
End of life wishes- One can state the things they would like to be done on their behalf when they die. These can include funeral guidelines such as cremation.
Principal execution
For an Advance Directive (Declarant) to issue directives to medical personnel, the principal must declare that they issued the directions outlined in the document.
You can do this by writing a declaration with the following information.
- Signatures and signature date
- Principal name (official)
- Principal address(address, city, state, zip code)
- Witnesses (name, signatures, and signature dates)- Two witnesses are recommended. The first witness reviews the document after the principal signs and then reads the confirmation statement of the principal. He or she then gives their name, signature, and the date they signed the document below their confirmation statement. The second witness follows the same procedure.
Notary acknowledgement
When the directive is being notarized, the notary public reviews the document and checks the witnesses’ confirmation statements. He or she then outlines their name, signatures, and date of signing at the bottom.
Once all these sections have been completed, the document can be notarized for validation. The notary public provides their state, name, signature, and date of signing.
Signing Requirements
The signing requirements, as earlier stated, will vary from one state to another. However, like common law, witnesses should not be related to the principal, agent, or in any way be beneficiaries in the principal’s testament. If it must be notarized, the notary public should not appear as a witness.
Below are the different state laws that guide the signing of an Advance directive in their respective states.
Registration of Advance Directive Form
As earlier mentioned, you can choose to register your form. This can be executed at the state or national level.
As not all states have a registry, below are some of the applicable registries:
State registries
- Alaska (AS 13.52.177) –Donor Registry
- West Virginia – Registration Form
- California (§ 4800 – § 4806) – Registration Form
- Arizona (A.R.S. § 36-32-7) – Registration Form
- Louisiana (R.S. 40:1151.2) – Instructions
- Montana (§ 50-9-501) – Registration Form
- Nevada – Registration Form
- Idaho (§ 39-4515) – Registration Form
- North Carolina – Registration Form
- Virginia (§ 54.1-2983) – Online Registration
- Vermont – Registration Form
National registries
- JoinCake – 100% free
- Everplans – $75/yr
- U.S. Registry – with charges at $59.95/5 years ($25 for additional five years)
Tips to Consider for Advance Directive
The quality of an Advance Directive can be improved by incorporating a few writing guidelines. Keeping in mind the legality of Directive, it is important to write one that serves its purpose. How do you do this?
Here are several tips you should consider:
Be concise
When issuing instructions in this form, the instructions should be specific. Vague directions can be challenging to interpret, and your agent or medical personnel might end up doing contrary to what you expected.
When outlining specific directives one can state if:
- They would like cardiopulmonary resuscitation (CPR) should their heart stop.
- They can be placed on an Oxygen machine in a situation where they cannot breathe on their own.
- They can be put in a blood-cleaning (dialysis) machine if their kidney fails.
- They would like to be fed through tubes if they cannot eat or drink independently.
- They would like to be administered medication for serious illnesses.
Communicate
It is wise to establish good communication between you, your agent, and health care providers. Involved parties should be open about their opinions, and you (the principal), being the facilitator, should create such an environment. Communication can be in case of any changes, seeking information about your condition or treatment options from medical personnel and when expressing your wishes. Any updates/alterations to your advance Directive should be communicated to the parties, witnessed, and signed by involved parties.
Distribute
Once completed, involved parties, that is, stand-in-decision maker, alternate agent, and doctor, should be issued with a copy of the document. Friends and family should be notified of its existence and location of a copy of the same.
Frequently Asked Questions
These are decisions that stand-in-decision makers, medical personnel, or family members have to make on behalf of a patient in a life-threatening condition or illness.
Yes. Before performing vital medical procedures, medical personnel must ask if the patient has an Advance Directive so that it can be used to make decisions from now on.
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