Advance Directive FAQs
What is an Advance Directive?
An Advance Directive (also known as an Advance Health Care Directive) is a way to make your healthcare wishes known if you are unable to speak for yourself or prefer someone else to speak for you. An AD can serve one or both of these functions:
- Power of Attorney for Healthcare (to appoint an health care agent)
- Instructions for Health Care (to indicate your wishes)
Is an Advance Directive different from a Living Will or a Medical Power of Attorney?
In California, the Living Will and Medical Power of Attorney forms are combined into a single document called an Advance Healthcare Directive.
Why do I need an Advance Directive?
People of all ages may unexpectedly be in a position where they cannot speak for themselves, such as an accident or severe illness. In these situations, having an AD assures that your doctor knows your wishes about the kind of care you want and/or who the person is that you want to make decisions on your behalf.
Does it mean that only one person can decide for me? What if I want others involved too?
Often many family members are involved in decision making, and most of the time, that works very well. Occasionally, people will disagree about the best course of action, so it is usually best to name one person as the agent (with a back-up, if you want). You may also indicate in your AD if there is someone who you do NOT want to make your decisions for you.
Should I name an alternate agent?
It is helpful to select at least one alternate agent, since your primary agent may be unreachable or unavailable (e.g., involved in a car accident with you).
What happens if I don't have an advance directive?
If you are not able to speak for yourself, the doctor and healthcare team will turn to one or more family members or friends. The most appropriate decision maker is the one with a close, caring relationship with you, is aware of your values and beliefs and is willing and able to make the needed decisions. Sample Cases
What kinds of things can I write in my Instructions for Health Care?
You can, if you wish, write your preferences about accepting or refusing life-sustaining treatment (like CPR, feeding tubes, breathing machines), receiving pain medication, making organ donations, indicating your main doctor for providing your care, or other things that express your wishes and values. If you have a chronic or serious illness, you may also want to talk with your doctor about specific treatments that you could face and ask him/her to help you document your decisions on a POLST form.
What is a POLST form?
POLST stands for Physician Orders for Life-Sustaining Treatment and was adopted in California in 2009. It is a voluntary form, which must be signed by you (or your agent) and your physician, nurse practitioner or physician assistant. A POLST indicates the types of life-sustaining treatment you do or do not want if you are seriously ill. POLST asks for information about your preferences for CPR, use of antibiotics, feeding tubes, etc. POLST doesn’t replace your AD, but when you are seriously ill, it helps translate it into medical orders that must be followed in all healthcare settings. What is a POLST
What can my agent do?
Your agent can make all decisions for you, just like you would if you could. Your agent can choose your doctor and where you will receive your care, speak with your healthcare team, review your medical record and authorize its release, accept or refuse medical treatments and make arrangements for you when you die. You should instruct your agent on these matters so he or she knows how to decide for you. The more you tell your agent the better he or she will be able to make those decisions on your behalf.
When does my agent make decisions for me?
Usually the agent makes decisions only if you are unable to make them yourself – such as, if you’ve lost the ability to understand things or communicate clearly. However, if you want, your agent can speak on your behalf at any time, even when you are still capable of making your own decisions. You can also appoint a “temporary” agent – for example, if you suddenly become ill, you can tell your doctor if there is someone else you want to make decisions for you. This oral instruction is just as legal as a written one.
Can I make up my own Advance Directive form or use one from another state?
Yes. Any type of form is legal as long as it has at least three things:
- Your signature and date,
- The signature of two qualified witnesses with their witness statements (see below), and
- If you reside in a skilled nursing facility, the signature of the patient advocate or ombudsman.
What is a witness statement?
Witnesses must sign a statement on the AD indicating that they a) know who you are or have been shown proof of your identity, b) are 18 years old or more, c) are not your healthcare provider or working for your provider, d) are not your healthcare agent, and e) are not employed in the place where you live.
One of the two witnesses must sign a statement indicating that they are not related to you by blood, marriage or adoption and will not receive any property or money from you after your death.
Do I need an attorney to help with my Advance Directive?
No. While advance care planning is often done as a part of estate planning with an attorney, it is not necessary to use an attorney to complete an AD.
What should I do with the form after I complete it and have it witnessed?
Make copies for all those who are close to you. Take one to your doctor to discuss and ask that it be included in your medical record. Photocopied forms are just as valid as the original. Be sure to keep a copy for yourself in a visible, easy-to-find location – not locked in a drawer.
What if I change my mind about what’s in my Advance Directive?
You can revoke or revise your AD at any time as long as you are capable of making your own decisions. It is important to review your advance directive periodically, such as after important life changes or if you have been diagnosed with a serious or progressive illness, to make sure the information on your Agent is correct and the medical information matches your current wishes.
If I make changes to my Advance Directive, do I need to fill out a new form and get it witnessed?
Small updates, such as changes in address or phone numbers, can be entered into the original form by drawing a line through the old information and writing in the new information. Substantial changes, such as changing your Agents or medical treatment wishes, require a new form. It is important that your form is easy to understand and that there be no questions regarding your wishes. If you do make changes, be sure to destroy old copies and share new copies with your doctor and agent.