Advance directives are legal documents that allow a person to spell out their decisions about end-of-life care ahead of time. They allow people to tell their wishes to family, friends, and health care professionals and to avoid confusion later on if they were too ill or injured to express their decisions.
Deeper dive
Advance directives allow people to decide what kind of care they want at life’s end by setting out their preferences in a living will, a do-not-resuscitate order, or by giving the power of medical decision-making to a friend or family member through a durable power of attorney for healthcare. They are designed to respect patient autonomy by defining current and future medical interventions according to the person’s values, wishes and priorities.
The idea behind advance directives makes sense, intuitively. It’s better to be prepared for what might come up at the end of life than to be caught unaware when a crisis is at hand. Ideally, a person should have conversations with family and physicians about their values and goals of care at life’s end rather than leaving essential wishes unexpressed.
But end-of-life planning isn’t nearly as simple as it may seem on the surface. With illness, someone’s perspective may change. What may have seemed intolerable when a person was healthy and independent may seem acceptable when they become more frail and dependent. Treatments that may have been refused under living wills prepared years or months earlier may suddenly seem desirable and necessary, as this New York Times opinion piece points out.
Another type of advance directive is known as “physician orders for life sustaining treatment.” Advance directives are also now being used for psychiatric care; for more information consult the National Resource Center on Psychiatric Advance Directives. It’s important to note that most states have their own forms for advance directives and durable health care power of attorney (sometimes referred to as a health care proxy).