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Week of 10.9.09

Living Wills and Advance Directives: What You Need to Know

Caring Connections provides information on advance directives in each state. Select yours from the drop down menu. [pdfs]
This information is excerpted from the Caring Connections website.

What are Advance Directives?

A living will allows you to document your wishes concerning medical treatments at the end-of-life.

Before your living will can guide medical decision-making, two physicians must certify:
  • You are unable to make medical decisions,
  • You are in the medical condition specified in the state's living will law (such as "terminal illness" or "permanent unconsciousness"),
  • Other requirements also may apply, depending upon the state.
A medical power of attorney (or healthcare proxy) allows you to appoint a person you trust as your healthcare agent (or surrogate decision maker), who is authorized to make medical decisions on your behalf.

Before a medical power of attorney goes into effect, a person's physician must conclude that they are unable to make their own medical decisions. In addition:
  • If a person regains the ability to make decisions, the agent cannot continue to act on the person's behalf.
  • Many states have additional requirements that apply only to decisions about life-sustaining medical treatments.
  • For example, before your agent can refuse a life-sustaining treatment on your behalf, a second physician may have to confirm your doctor's assessment that you are incapable of making treatment decisions.
What Else Do I Need to Know?
  • Advance directives are legally valid throughout the United States. While you do not need a lawyer to fill out an advance directive, your advance directive becomes legally valid as soon as you sign them in front of the required witnesses. The laws governing advance directives vary from state to state, so it is important to complete and sign advance directives that comply with your state's law. Also, advance directives can have different titles in different states.
  • Emergency medical technicians cannot honor living wills or medical powers of attorney. Once emergency personnel have been called, they must do what is necessary to stabilize a person for transfer to a hospital, both from accident sites and from a home or other facility. After a physician fully evaluates the person's condition and determines the underlying conditions, advance directives can be implemented.
  • One state's advance directive does not always work in another state. Some states do honor advance directives from another state; others will honor out-of-state advance directives as long as they are similar to the state's own law; and some states do not have an answer to this question. The best solution is if you spend a significant amount of time in more than one state, you should complete the advance directives for all the states you spend a significant amount of time in.
  • Advance directives do not expire. An advance directive remains in effect until you change it. If you complete a new advance directive, it invalidates the previous one.
  • You should review your advance directives periodically to ensure that they still reflect your wishes. If you want to change anything in an advance directive once you have completed it, you should complete a whole new document.
Preparing Your Advance Directives

Before you prepare your advance directives:
  • Get information on the types of life-sustaining treatments that are available.
  • Decide what types of treatment you would want or would not want.
  • Share your end-of-life wishes and preferences with your loved ones.
Preparing your own advance directives:
  • You do not need a lawyer to prepare advance directives.
  • Make sure you prepare your advance directive to accurately reflect your decisions.
  • Complete your state-specific advance directives.
  • In most states, you can include special requests in your advance directives such as wishes about organ donation, cremation or burial.
  • You also should be sure to make your physician and loved ones aware of your specific requests so appropriate referrals and arrangements can be made.
  • Ask someone else to look over the documents for you to be sure that you have filled them out correctly.
  • Read all of the instructions carefully to ensure that you have included all of the necessary information and that your documents are witnessed properly.
What to do after your advance directives are signed:
  • Make several photocopies of the completed documents.
  • Keep the original documents in a safe but easily accessible place, and tell others where you put them; you can note on the photocopies the location where the originals are kept.
  • Do not keep your advance directives in a safe deposit box. Other people may need access to them.
  • Give photocopies to your agent and alternate agent.
  • Be sure your doctors have copies of your advance directives and give copies to everyone who might be involved with your healthcare, such as your family, clergy, or friends. Your local hospital might also be willing to file your advance directives in case you are admitted in the future.
Once you have completed your advance directive you need to talk to anyone who might be involved in your healthcare decision making. This includes family members, loved ones and your healthcare providers. You want them to understand how you feel about medical treatment at the end-of-life.

Caring Connections is a program of the National Hospice and Palliative Care Organization. For questions contact Caring Connections

These materials are copyrighted by Caring Connections. Permission is granted to download a single copy of any portion of these texts. Use by individuals for personal and family benefit is specifically authorized and encouraged. Further copies or publication are prohibited without express written permission. Caring Connections can be contacted here.
 
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