Tomorrow, April 16th, is National Healthcare Decisions Day. Initiated in 2008 by Virginia-based healthcare attorney Nathan Kottkamp, its mission is to provide ample, concise, straightforward information on healthcare decision-making to both the public and healthcare providers and facilities. In short, NHDD seeks to promote and demystify what’s involved in all-important advance care planning, making it accessible to everyone.

First, though seniors may be more at risk, advance care planning is not only about making plans for getting older. A medical crisis including disease, automobile accident, or other form of severe injury can strike at any age, leaving you vulnerable and unable to make your own healthcare decisions. Planning now for healthcare in the distant and near future is a key component in ensuring you get the kind of medical treatment you want—including measures you may not want. This includes having the instructions in place for life and death decisions if you are unable to advocate for yourself, where doctors and family members need to know what actions to take for you.

What is an Advance Directive?

The Centers for Disease Control and Prevention (CDC) reports 70 percent of Americans have no advance care plan in place. When crisis strikes, this puts the burden on emotional family members, and/or a healthcare team that has no personal connection to the patient. While the idea of having to face these issues ahead of time may be unpleasant, an advance directive is actually a gift you give to family members who may otherwise spend the rest of their lives wondering if they “did the right thing.”

A legal document activated when you are incapacitated and unable to speak for yourself, among the items that can go into this document is the name of your designated healthcare representative, also known as healthcare proxy or durable power of attorney. Your wishes about using a ventilator, feeding tube, and instructions about CPR and DNR (do not resuscitate) orders are also included, as is length of time certain life-prolonging measures need to be in place before terminating. Thoughts about end-of-life palliative care are also a good idea.

An Advance Directive Brings Clarity to Gray Areas

Following a skiing accident, 54-year-old Paige Paulson suffered a head injury and a broken back and neck, resulting in a weeks-long coma on a ventilator. At one point three weeks into the ordeal, doctors approached the family about suspending life support when it appeared the odds of Paige pulling through were against her. Even if she did, they posited, her quality of life may be severely compromised. Because she had an advance directive in place, the family did not have to make any decisions knowing they were explicit in the document. Just days later Paige emerged, and though her recovery took nearly a year, most of it strenuously spent in a physical rehab facility, she did come back.

Clearly ideas about how we wish to live or die are not one size fits all. These viewpoints also change as we age so an advance directive from a 35-year-old will likely not reflect the same ideals and instructions as one from an 80-year-old. To this end an advance directive can always be updated. A new health diagnosis or change in marital status can impact your wishes and instructions, as can scenarios that include someone wanting to live long no matter what (total paralysis; feeding tube; severe mental impairment caused by stroke; ventilator; coma). Or perhaps quality of life supersedes all that. When things are spelled out in an advance directive, updated at least every decade or sooner, there is imminent peace of mind for all concerned.

What Goes into an Advance Directive?

An advance directive is comprised of two main elements: a living will and durable power of attorney for healthcare. Other advance planning materials can follow, but a living will tells medical personnel how you want and don’t want to be treated in the Decisions That Could Come Up section, and under which conditions each of your choices applies.

A durable power of attorney for healthcare names a healthcare proxy (also known as a surrogate, representative, or agent) who makes decisions for you when you cannot. This trusted individual should be someone close to you, thereby familiar with your life and values. Some people have a healthcare proxy in lieu of a living will, but the best method in order to leave no stone unturned—nothing open to debate, question, confusion, interpretation, or later regret—is to have both.

In addition to the living will and durable power of attorney for healthcare, supporting advance planning documents may include:

  • DNR (do not resuscitate) order, also known as a DNAR (do not attempt resuscitation), or AND (allow natural death).
  • Similarly, a DNI (do not intubate) order tells medical personnel not to intubate you.
  • Organ and tissue donation instructions may also be included, and many people carry a card like this in their wallets or it is designated on a driver’s license.
  • POLST (physician/provider orders for life-sustaining treatment) or MOLST (medical orders for life-sustaining treatment) are generally created by your doctor when you are critically ill and/or nearing the end of your life. They include orders for medical staff to follow when you know the decisions that will likely need to be made during this time. If you are in a hospital or facility, it is posted near your bed.
  • Your thoughts about what you want your loved ones to know.

Creating an Advance Directive

States have different forms and requirements for creating these legal documents. Some require witnesses, signatures, and/or notarization. Attorney involvement can be sought but is typically unnecessary. State-specific forms can often be obtained from hospitals and other healthcare facilities, or by links available on the AARP, American Bar Association, and National Hospice and Palliative Care Organization websites, to name a few.

Once completed, be sure to distribute copies to all health care providers, hospitals, your healthcare proxy, and attorney if you have one. Some people want family members to have one on file as well. As mentioned earlier, an advance directive is without a doubt the gift you give family members. It is for a time in your life when they should not have to shoulder the burden of making crucial decisions, the results of which can impact the rest of their lives.


“What is Advance Care Planning and What Steps Do You Need to Take?,” was written by Beth Herman, Amada blog contributor.