If you are in an accident, injured, seriously ill or confused, your hospital will need to make decisions related to your health care. If you do not have an advance directive – that is, a living will or durable power of attorney (DPOA) – the following may be making decisions for you:

• family
• physicians
• lawyer
• hospital
• judge

Protect your right to control your health care decisions – put it in writing!  Before you go to the hospital, take the time to talk with your family, friends, and physicians about the medical care you want if you should become seriously ill and not able to communicate. Taking this step while you are of sound mind can help you play an active role in making decisions about your health care and protect your autonomy and self-determination. 

When you are admitted to the hospital, the admissions department will most likely ask you if you have a living will or proxy. A proxy is many times described as durable power of attorney (DPOA), durable medical power of attorney, power of attorney, surrogate or agent. It is important to know that these are all the same. If you do have a living will or proxy, share this information with your admissions department. If you do not, ask how you may get your wishes or living will and proxy in writing.

It is important to remember that you may change your living will or proxy at any time. Many patients hesitate to put their wishes in writing. They fear that if they do, they cannot change their health care plan or end-of-life decisions. If your decisions change, let your clinical nurse specialist (CNS), nurse practitioner (NP), registered nurse (RN), or physician know you have changed your mind regarding your health care plan.

Most hospital systems have an ethics committee to assist in making health care and end-of-life decisions. These ethics committees are generally made up of physicians, nurses, clergy, social workers, lay persons and bioethicists. Because of the growing ability of technology, it is more likely that you will be placed on machines if you do not have a living will or proxy. Nurses and physicians are trained to provide all that is necessary to maintain life in their patients. If you do not have the same belief – get your values and beliefs in writing.

Types of Advance Directives

 An advance directive is a legal document that states what you want to happen if there is no reasonable hope for your recovery.  As such, advance directives can help you play an active role in determining your health care decisions.  The types of advance directives are:

• Living wills
• Health care proxies (durable health care power of attorney)

The Patient Self-Determination Act of 1991 mandated that all health care facilities obtain either a living will or durable power from patients being admitted to their hospital.

Living Will

A living will directs your health care per your wishes and does not need a lawyer. These are your wishes about your medical care in writing. Some of the issues to address include:

• Family finances
• Conditions that would make life intolerable for you
• The use of dialysis and breathing machines
• Tube feeding
• If you want to be resuscitated if you stop breathing or your heart stops beating
• Organ or tissue donation
• Your views about death

It can be helpful to talk with your family and your physician about these issues as you decide what choices to make. Also, find out what laws apply in your state.

Most states provide a living will template, but you can also complete a generic form or simply state your wishes on paper. Regardless of the format, you must follow your state’s requirements for witnesses. Two witnesses are usually required and they should be people who know you well, but not your health care provider, relatives, or anyone who could benefit from your death, such as heirs.

Do Not Resuscitate (DNR):

Before you make your living will decision, it is important to understand resuscitation policies of most hospitals. Do Not Resuscitate (DNR) policies can be different from hospital to hospital.  Be sure to ask what your hospital DNR policy is.

When you choose DNR, health care workers carryout the following:

• Suction your airway
• Administer oxygen
• Position for comfort
• Splint or immobilize
• Control bleeding
• Provide pain medication
• Provide emotional support

When you choose DNR, health care workers do not carryout are the following:

• Administer chest compressions or CPR
• Defibrillate to cardiovert your heart
• Insert an artificial airway or ventilator support
• Administer resuscitative medications
• Start IVs or invasive cardiac monitoring
• Provide respiratory assistance other than what is listed above
   

Health Care (or Medical) Durable Power of Attorney 

A durable medical power of attorney (DPOA) allows you to choose someone to carry out your health care wishes if you are no longer able to act for yourself. You may draw up a DPOA with or without the advice of an attorney. Most states provide suggested forms.

You can have both directives: the living will helps your health care proxy make decisions according to your specified wishes. You may also make changes to your living will and/or DPOA – or revoke them – at any time.
 

The Importance of Advance Directives

As medical care continues to improve and technology allows lives to be prolonged even when there is no hope of recovery, advance directives become more necessary. Legal cases disputing the treatment of comatose patients highlight the importance of having wishes stated in advance.

Take an active step in your health care while you are healthy. You do not want to be tied to a bed, confused and connected to machines if these are not your wishes. Nurses and physicians are trained to keep you alive unless you let them know what your values and wishes are. Maintain your self-determination by making a Living Will and electing a Proxy.

By preparing these documents and having them ready before your hospital admission, you can make legally valid decisions about your future medical treatment.

Additional Resources

Advance Directives (Medline Plus)
Consumer’s Tool Kit for Health Care Advance Planning (American Bar Association)
Put It in Writing (Also in Spanish)
U.S. Living Will Registry

For more information:

Go to the Wellness Center health topic.