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Advance care directives

Living will; Power of attorney; DNR - advance directive; Do not resuscitate - advance directive; Do-not-resuscitate - advance directive; Durable power of attorney - advance care directive; POA - advance care directive; Health care agent - advance care directive; Health care proxy - advance care directive; End-of-life-advance care directive; Life-support - advance care directive

When you are very ill or injured, you may not be able to make health care choices for yourself. If you are unable to speak for yourself, your health care providers may be unclear as to what type of care you would prefer. Your family members may be uncertain or disagree about the type of medical care you should receive. An advance care directive is a legal document that tells your providers and others involved in helping you what care you agree to or decline in advance of this type of situation.

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Why Write an Advance Directive?

With an advance care directive, you can tell your providers what medical treatment you do not want to have and what treatment you want no matter how ill you are.

Writing an advance care directive may be difficult. You need to:

• Know and understand your treatment options.
• Decide future treatment options you may or may not want.
• Discuss your choices with your family.

Living Wills

A living will (advance care directive) explains the care you do or do not want. In it, you can state your wishes about receiving:

• CPR (cardiopulmonary resuscitation) if your breathing stops or your heart stops beating
• Feedings through a tube into a vein (IV) or into your stomach
• Extended care on a breathing machine
• Tests, medicines, or surgeries
• Blood transfusions

Each state has laws about living wills. You can find out about the laws in your state from your providers, the state law organization, community social workers, and most hospitals.

You should also know that:

• A living will does not deal with financial issues, and is not the same as a last will and testament after a person's death.
• You are not able to name someone to make health care decisions for you in a living will.

Other Types of Advance Directives

Other types of advance directives include:

• Special health care power of attorney is a legal document that allows you to name someone else (a health care agent or proxy) to make health care decisions for you when you cannot. It does not give power to anyone to make legal or financial decisions for you.
• A do-not-resuscitate order (DNR) is a document that tells providers not to do CPR if your breathing stops or your heart stops beating. Your provider talks to you, the proxy, or family about this choice. The provider writes the order on your medical chart.
• Fill out an organ donation authorization card and carry it in your wallet if you wish to be an organ donor after death. Keep a second card with your important papers. You can find out about organ donation from your provider. You can also have this choice listed on your driver's license.
• Verbal instructions are your choices about care that you tell providers or family members. Verbal wishes may supplement those you made previously in writing. It is best to avoid confusion by putting your wishes in writing whenever possible.

Additional Information

Write your living will or health care power of attorney according to your state's laws. Your attorney, provider, hospital or community social worker will be able to help you with proper documentation.

• Give copies to your family members, providers, and health care agent.
• Carry a copy with you in your wallet or the glove compartment of your car.
• Take a copy with you if you are in a hospital. Tell all medical staff involved in your care about these documents.

You can change your decisions at any time. Be sure to tell everyone involved, family members, proxies, and providers, if you make changes to your advance directive or a living will is changed. Copy, save, and share the new documents with them.

References

Arnold RM, Kutner JS. Palliative care. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 3.

National Institute on Aging website. Advance Care Planning: Advance Directives for Health Care. www.nia.nih.gov/health/advance-care-planning/advance-care-planning-advance-directives-health-care#find. Updated October 31, 2022. Accessed February 13, 2024.

Shreves A, Quest TE. End of life. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap e5.

Review Date: 2/3/2024  

Reviewed By: Frank D. Brodkey, MD, FCCM, Associate Professor, Section of Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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