fundamentals
Advance Directives
Introduction
Health care advance directives are legal documents that communicate a person’s wishes about health care decisions in the event the person becomes incapable of making health care decisions. There are two basic kinds of advance directives: Living Will and Aliving willexpresses, in advance, a person’s instructions or preferences about future medical treatments, particularly end-of-life care, in the event the person loses capacity to make health care decisions. Ahealth care power of attorneyappoints a person (typically called a health care agent, but also proxy, health care representative, or other name depending on the state) to make decisions for the person (the principal) in the event of incapacity (temporary or permanent) to make health care decisions. If someone does not have capacity to make or communicate a health care decision and does not have a court-appointed surrogate (guardian or conservator) nor a self-appointed surrogate (agent or proxy), then health care professionals usually rely on the next of kin or even a close friend as the Default Surrogate Decision Making . Most states authorize default surrogate decision makers, usually next of kin; however, the exact scope of authority and the priority of permissible surrogates vary by state. When state law does not authorize a default surrogate decision maker and doctors and hospitals turn to next of kin, the extent of their legal authority becomes less clear. In the rare event that the issue is referred to a court, courts generally prefer to name a family member as guardian or conservator to make health care decisions, but they may also turn to a friend or a stranger to direct care. A health care power of attorney (and a living will if it provides useful guidance) eliminates almost any need for the courts to get involved and helps ensure that the person’s health care decisions will be respected. Ideally, copies of the living will or health care power of attorney should be given to every doctor providing care for the principal and to the hospital upon admission. Copies should also be placed in the principal’s permanent medical record, given to the principal’s appointed agent and lawyer, and placed with important papers. People should also provide copies to other close family or friends who will likely be involved during serious illness. This helps avoid surprise and controversy when difficult decisions have to be made by the agent. Web-based databases that store information about peoples' advanced directives and that can be accessed by health care professionals are becoming increasingly available. Advance directive smartphone apps are also available, allowing people to store advance directives, share them with family members, and send them electronically to doctors. Having multiple advance directives or ones that are overly complicated can create confusion. If there is both a living will and a health care power of attorney, the principal should stipulate which should be followed if the documents seem to conflict. 