Writing an Advance Directive

When an Advance Directive Is Crucial

An advance directive is crucial for having control over your own medical care if you become unable to make decisions or cannot communicate your wishes. It is also a way to share your feelings with your family and help them if they ever need to make decisions about your medical treatment. An advance directive may become important if you are severely injured or develop a serious illness that prevents you from actively participating in your medical care. A living will and a medical power of attorney, which assigns a health care agent, are the two fundamental types of advance directives.

A living will, also called a treatment directive, outlines your general preferences for medical treatment if you develop a terminal or irreversible illness or injury and are unlikely to regain the ability to make decisions. In these circumstances, a living will can document your wishes about issues such as life-sustaining treatments and pain management.

Do not assume that your doctor and family will know your preferences if you have not prepared an advance directive or discussed your preferences with them. Communicating about these documents can help you feel assured that your wishes are understood. It can also help prevent your loved ones from potentially having to carry the burden of making difficult decisions on your behalf without knowing what you want.

Without a living will and a health care agent, decisions about your medical care may sometimes be made by a doctor who does not know you, or even by the courts, rather than by your family or your health care agent. In several states, you have to state your permission in your advance directive to not use or to withdraw feeding tubes

It is especially important to have a living will and a health care agent if you would not want to be kept alive by artificial nutrition and hydration, such as a feeding tube. In several states, you have to give your permission in your advance directive to not use or to withdraw feeding tubes.

Some people are not comfortable with having an advance directive—in particular, a living will. This may be because of religious or spiritual reasons or other beliefs and values. If you choose not to have a living will, your family and your doctor should respect your decision.

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Author:	Jeannette Curtis	Last Updated: December 27, 2007
Medical Review:	Kathleen Romito, MD - Family Medicine Shelly R. Garone, MD - Palliative Care
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