What is in an Advance Directive

An Advance Directive is a document that directs your medical team and loved ones to provide or withhold certain kinds of medical care in case you cannot speak for yourself. An advance directive usually includes:

• A living will to express your wishes for care.
• A health care power of attorney, which names the person or persons that you want to make decisions for you, known as proxies.
• A health information release form, which allows your medical providers to release your information to specific people.

An Advance Directive is an important document for everyone. People who are faced with a life threatening disease should have an Advanced Directive to assure that if they can not express their wishes for care, these wishes are known to their caregivers and health care team. A Health Information Release will assure that your proxies and family members have access to your health information to make medical decisions if you are incapacitated.

Living Will

A living will documents your wishes for life support. Consider what you would want done if you were near death and could not speak for yourself. The life support options that might be offered include:

• Artificial nutrition or hydration, which is food or water given through an intravenous infusion or tube feeding.
• Defibrillation, which is applying an electrical shock to the chest to try to restart the heart after it has stopped.
• A ventilator, also called a respirator, which is a machine that pushes air into the lungs through a tube placed down the throat.

Life support may also be treatments specific to an illness that are likely to improve the condition of, but may or may not postpone death in, a terminally ill person. Examples include blood transfusions; intravenous antibiotics; or dialysis, a mechanical means of cleaning the blood when the kidneys no longer function.

Health Care Power of Attorney

Designating a health care proxy is optional. However, if you become too ill to talk, your preferences for care are more likely to be followed if you have designated one or two people to speak on your behalf. This person is called your health care proxy. The proxy part of the advance directive is referred to as the durable power of attorney for health care.

Your advance directive authorizes your proxy to make health care decisions for you, even about issues that you did not specifically identify. A proxy is typically authorized to:

• Make health care decisions on your behalf, based on preferences you have stated orally or in a living will document.

• Agree to, refuse, or withdraw treatment on your behalf.
• Review any medical records that you would have a right to access.
• Take legal action, if necessary, to carry out your wishes.

• Apply for Medicare, Medicaid, or other benefits on your behalf.

• Make any other health care decisions for you, based on your personal values and best interests, if your wishes are unknown.

To figure out who you would like to have as a proxy, ask yourself questions such as:

• Who do I trust?
• Who will keep my wishes (and not theirs) in mind as they make decisions?
• Who could handle the responsibility?
• Who could communicate well and negotiate with medical professionals?

Your proxy must be able to put him- or herself in your shoes, trying to do what you would do without his or her own biases. It is not enough for you to just name someone as your proxy. You need to talk to your proxy(ies) and tell them in advance what you would do and what is important to you. You may need to have more than one conversation, discussing new issues as they arise.

Health Care Information Release

The Health Insurance Portability and Accountability Act (HIPAA) protects the privacy of your health information and puts limits on who can receive that information. This part of your advance directive will authorize specific people to discuss your medical situation with your health care team, whether you are able to speak for yourself or not. These people cannot make decisions for you, but are able to know and discuss with your health care team what's going on.