Monday, February 20, 2012

Advance healthcare directives- what are they, and do I need one?

     Advance healthcare directives are a subject that can be awkward or difficult to bring up. However, writing one is extremely important. It will ensure that your values and choices regarding the end of your life are put into effect and lessen the decision-making burden for your family and friends if an end-of-life situation occurs.

     Put simply, an advance directive is a document that will guide your family, friends, and doctors if you were ever unable to make your own medical decisions. They generally have two parts. The first part identifies someone who can make medical decisions for you. This person, sometimes referred to as the “healthcare agent,” can be anyone you choose. You can specify if your agent will be able to start making decisions right away or if he or she must wait until a doctor says that you are no longer able to make decisions for yourself. If you feel comfortable leaving all medical decisions up to your healthcare agent then you have just completed your advance directive and can skip part two.

     If, however, you would like to include more specific instructions to guide your agent, part two is very important. Often called the “living will” portion of an advance directive, part two gives instructions for specific situations such as inevitable death from a terminal condition, comas, or complete physical dependency caused by an advanced disease. In the living will, you can specify how you would like each of these situations handled. Maybe you prefer that you are allowed a natural death without any measures being taken to extend your life. Or perhaps you would like doctors to use any means possible to extend your life in case your condition changes. Maybe you fall somewhere in between. In any case it is very important that you make these decisions now while you are able.

Sharing Your Decision
     Once you make these decisions, be sure to discuss them with your loved ones. This will help your family understand your choices. Some of your loved ones may not agree with you, but they should understand that you have made the decision that you feel is best. The last thing that anyone wants is to leave behind a family that has become divided over end-of-life medical care. Explain that you have made these decisions so that your values are upheld and so that your family is not forced to make difficult decisions in an already difficult time.

     So when is it a good time to begin to think about creating an advance directive? Now! A great reason to get started on your own advance directive is that it makes it easier to discuss the subject with your loved ones who don’t have one. Simply say “hey (mom, dad, brother, sister, friend, significant other, etc.) I’ve been thinking about writing an advance directive. Have you ever given any thought to what you want us to do if you can’t make your own medical decisions?”

     There are tons of great resources all over the web to help you with the creation of your own advance directive. The Maryland Attorney General has an informative document with a template that you can use to create your own directive. The National Hospice and Palliative Care Organization also has great resources, as does the Meritus Health website. You may also want to consider speaking with your doctor so that you can understand the consequences of any decisions you make.

     Nobody wants to think about their own death or the death of a loved one, but hopefully you can see the benefits of writing an advance directive while you are of sound mind. Here’s to hoping that you will never have to make use of it!

By Shawn McNally


  1. go to a lawyer! it is not an advanced directive should be incorporated into an irrevocable trust. please use the information as merely guidelines. if you don't post this, many people are going to misinformed

    1. Sujana, thanks so much for your response. You are correct that these are merely guidelines for advanced directives, but our hope is that by reading these guidelines, people begin to think about how it applies to their situation. We encourage everyone to do more research on their own and contact any advisers they deem appropriate.