Advance Directives: Making Crucial Healthcare Decisions Before an Emergency

stethoscope and judge's gavel

No one wants to think about what would happen if heart attack, stroke, severe illness or injury were to strike. Among the many disturbing questions for such a scenario is: How will my doctors know my treatment preferences if for some reason I cannot communicate?

There are important steps you can take in advance to document your healthcare desires. A very common option is to create an advance directive.

What Advance Directives Can Do

Advance directives, also referred to as living wills, can address a number of issues, such as whether a patient wants to receive artificial respiration, dialysis, tube feeding or artificial hydration, or donate an organ in the event of death. The document may also include a do-not-resuscitate-order, which instructs doctors not to perform CPR if the patient stops breathing or their heart stops.

“An advance directive provides a clear statement by the patient of his or her wishes with respect to his or her health care,” said William Roach Jr., Esq., an American Heart Association volunteer and co-author of Medical Records and the Law, now in its fourth edition. “This helps to avoid disputes that can arise among family members concerning how to treat an incapacitated relative and gives direction to healthcare providers concerning the level of care to provide the patient.”

An advance directive may also include a durable power of attorney for health care or healthcare proxy, in which the patient names another person to make healthcare decisions for them if they are unable to do so.

However, the individual (often referred to as an advocate or surrogate) named in this document cannot make the decision to terminate life-sustaining care unless this is specified in the durable power of attorney document.

Who Can Create Advance Directives

Advance directives are available to any adult, regardless of health status. However, no one is required to create advance directives, and advance directives can be revoked at any time at the patient’s request.

Before providing care, hospitals are required by law to ask patients if they have an advance directive and provide guidance and necessary documents if the patient chooses to create one.

If a patient is unable to make healthcare decisions and does not have an advance directive, healthcare providers will consult with the patient’s spouse, adult children, parents, siblings or other adult relatives, among others, as required by state law.

How to Create Advance Directives

To create an advance directive, contact your doctor or an area hospital. You may also want to contact an attorney, although this is not a requirement.

Many organizations, including the National Hospice and Palliative Care Organization(link opens in new window), provide state-specific advance directive instructions and forms. Laws regarding advance directives vary from state to state.

To learn more about the laws in your state, visit the U.S. Living Will Registry website.

The National Institutes of Health has more information on advance directives(link opens in new window).