Make Sure Your Wishes in Your Advance Directive for Medical Care Are Followed

Estimates are that fewer than a fourth of the people in the United States have an advance directive, which is a statement that you make in advance of the time that it is needed directing decisions about life-sustaining medical care after you are no longer able to communicate your wishes. Basically, an advance directive, either a medical proxy or a living will, brings up death and dying, issues that most of us are not comfortable bringing up with our loved ones.

Younger people feel that they do not need one, although Terry Schaivo (more) and Karen Ann Quinlan (more ), two of the best-known people whose friends and families certainly would have benefited from an advance directive, were under thirty when their medical catastrophes occurred. Members of minority groups and poor people may fear that an advance directive might be used to deny them proper medical care, and they may lack access to appropriate legal and medical advice.

According to a Harvard University study, the main reason given for not having an advance directive was that health care professionals had not brought up the issue. Some physicians feel threatened by patients empowering themselves with an advance directive. In fact, physicians may not even know enough about an advance directive to provide information.

Know what an advance directive is, and whether you have a living will or a medical proxy.

An advance directive is a statement that you make in advance of the time that it is needed directing decisions about life-sustaining medical care after you are no longer able to communicate your wishes. (Learn about the basic terminology of the advance directive here.)

A health care power of attorney or durable power of attorney or proxy allows someone, usually a family member or friend to make health care decisions for you after you are no longer able to speak on your own behalf. A living will is your statement of what life-saving medical treatment you wish to be given, and under what circumstances.

Make your advance directive accessible.

If the documents of your living will or medical proxy are in a safe deposit box, your family and friends may not be able to access them. Your hospital and physician may not have a copy in your files.

State your wishes clearly in your advance directive.

Write your advance directive with clear and specific language. Some language may not even be appropriate in a legal document. Your directive needs to be up to date, reflecting your current beliefs and wishes.

For a health care proxy, clearly state your wishes in regard to medical intervention. The decisions should be based on your wishes, not what the proxy may want or may think that you want. Consider that if you have a serious illness, you may change your mind about your wishes and values, and you should keep the documents appropriately updated.

One reason that medical personnel ignore advance directives is that such directives are not clearly stated. Such uncertainty may lead to differing interpretations by the medical staff and the friends and family. Considering that some physicians cling to the authoritarian (doctor-knows-best) model and that some conscientious physicians may feel committed to preserving life (for some, because of religious convictions), you have a responsibility to word your advance directive so that your wishes can be clearly understood.

I am not qualified to provide legal advice, and you must select those legal and medical options that are appropriate for you and your family under the legal restraints of your state. You can read my other articles about medical care here.