Two main types of advance directives are living wills and healthcare power of attorney. These are legal documents that outline a person’s preferences regarding major medical decisions.

An advance directive is one potential part of advance care planning. It involves having conversations with loved ones or trusted people about medical care if an individual becomes seriously ill or is unable to communicate their wishes.

An advance directive is a legal document that outlines an individual’s wishes regarding future major medical decisions. These documents only take effect when the person cannot communicate their own wishes.

Typically, an advance directive addresses decisions related to end-of-life care. However, it can address any aspect of care. For example, many people use advance directives to focus on mental health treatments.

It is important to note that advance directive laws in the United States may differ by state, and each state may only allow certain types.

Healthcare proxy

A person can use an advance directive to name a healthcare proxy who acts as a surrogate, agent, or representative for them if they cannot make decisions for themselves.

A healthcare proxy will work closely with a person’s healthcare team to ensure they honor all their treatment and care preferences. Naming a healthcare proxy can be especially useful in unexpected situations, such as a stroke or car accident.

The requirements for healthcare proxies typically vary by state. In most states, a healthcare proxy must be over age 18. Many people choose a family member, while others may choose a lawyer, a trusted friend, or a neighbor.

While each state sets its own requirements, the American Bar Association generally recommends not choosing any of the following:

  • the owner or operator of your residential or healthcare facility
  • a healthcare professional, their spouse, their employee, or the spouse of an employee
  • any professional who is responsible for evaluating a person’s ability to make decisions
  • someone working for a government agency financially responsible for the individual’s care
  • a court-appointed conservator or guardian
  • someone who already serves as a healthcare proxy for 10 or more people

The two main types of advance directives are:

  • a living will
  • a durable power of attorney

Living will

A living will is a legal document that states a person’s wishes concerning certain future healthcare decisions. It only becomes effective if an individual becomes unable to make choices and decisions on their own.

It is called a “living” will because it is in effect while the person is alive. It often involves decisions regarding end-of-life care.

A living will can describe the circumstances under which a doctor should or should not attempt to prolong a person’s life. This applies to treatments such as:

  • dialysis
  • feeding tubes
  • life support

A living will to guide medical decisions can only take effect after two doctors confirm a person is unable to make decisions for themselves.

Things to consider

Things to consider when making a living will include:

  • do not resuscitate orders (DNR), an order not to use CPR if you stop breathing or your heart stops
  • the use of feeding tubes and IV fluids if you cannot eat or drink
  • the use of machines like dialysis or ventilators to keep you alive
  • a treatment plan for palliative care, such as pain management and care for nausea and other symptoms
  • donation of organs and other tissues after death

A person can choose to end or take back their living will at any time. However, a living will must comply with state law to be legally valid.

Durable power of attorney

A durable power of attorney is a legal document that allows an individual to appoint a proxy to make medical, legal, or financial decisions on their behalf.

Usually, a durable power of attorney comes into effect when a person can no longer make decisions on their own. However, some states recognize immediate durable power of attorney, meaning an individual’s proxy can make decisions right away.

Before a healthcare proxy can use the durable power of attorney to make medical decisions, a doctor must certify that the individual is unable to make decisions themselves.

Other types

There are two other types of advance directives:

  • Do Not Resuscitate Order (DNR): This is a written document signed by a healthcare professional that states whether a person wants resuscitation if they stop breathing or their heart stops. In most states, this is the only advance directive order Emergency Medical Services (EMS) have to consider. A DNR allows a person to choose which procedures to accept or decline.
  • Physician’s Orders for Life-Sustaining Treatment (POLST): A POLST is a newer type of advance directive that serves as an agreement between a doctor and an individual regarding a specific condition. The POLST documents the condition, summarizes a person’s wishes regarding treatment, and records their wishes as medical orders.

Anyone can consider setting up an advance directive. People of any age can face a medical crisis that could leave them unable to communicate their medical wishes.

However, advance directives may be more important for older people to consider.

Individuals with dementia may find it particularly important to put this document in place as soon as possible to protect their future needs and wishes. It allows them to participate directly in the decision making process regarding their care.

If someone does not have an advance directive and they become unable to make their own decisions, the laws in the state where they live determine who will make medical decisions on their behalf.

Generally, this may be:

  • a spouse
  • adult children
  • parents if they are available

If a person is unmarried and has not officially named their partner as their proxy, the partner may be unable to participate in the decision making.

If someone has no family, the state may appoint a close friend or a doctor to act in their best interest.

To find the laws in a specific state, contact the state legal aid office or state bar association.

To get started with creating an advance directive, consider the following:

  • Reflect: Take the time to reflect on individual values and wishes. This can help determine what matters most regarding end-of-life care and guide decisions.
  • Talk: Speak with a primary care doctor about advance directives. This can help a person learn more about their current health and what future decisions they may need to make.
  • Choose: Choose a trusted person as a healthcare proxy. Once a person has made this decision, speak with the chosen person about individual values and wishes.
  • Complete: Complete any necessary forms to create the desired type of advance directive.
  • Share: Share the completed advance directives with the healthcare proxy, loved ones, and doctors. Some states may even have a registry where a person can store their advance directive for easy access by healthcare professionals or their proxy.

It is a good idea to have regular conversations about an individual’s wishes and update the advance directive each year or after significant life changes.

Did you know?

Medicare covers advance care planning as part of the annual wellness visit. Medicare may also cover this type of service as part of medical treatment.

If a person receives this service from their doctor during their annual wellness visit, there is no cost to them. If they receive it during any other appointment or treatment, the Medicare Part B deductible and 20% coinsurance apply.

An advance directive is a legal document that outlines an individual’s wishes for medical care in situations where they are unable to make decisions themselves.

The main types of advance directives are the living will and the durable power of attorney. These allow a person to make their treatment wishes and values known to a healthcare proxy, who can make those decisions on their behalf if they cannot make them themselves.