What is an advance directive?
An advance directive is a legal document stating your medical wishes if you were ever unable to express them yourself.  This includes either appointing a durable power of attorney or having a living will (explained in more detail below).  It states to your doctor and/or health care worker what type of care you would want (i.e. no feeding tubes, etc.) if you were too ill to tell someone yourself.  You should know you are also able to change the documents at any time.  It is also written when you are deemed competent and able to understand what these decisions mean and how they will effect you. Also, it is recommended you give someone a copy of the advanced directive (i.e. your doctor) so your wishes can be properly carried out (do not leave your advanced directive in a safety deposit box where no one would be able to find it).   However, each state has slightly different variations to their advanced directive laws, so please refer to your local governmental authority or www.uslivingwilldirectory.com for further details.  

What is a Living Will?
A living will expresses your own healthcare wishes if you were unable to do so yourself in the written form.  For example, if you were in a coma (let’s say, from an accident) and you never wanted to have a feeding tube placed.  If you stated this in your living will, then a feeding tube will not be placed if this was documented in your living will advanced directive.  Some other living will directives may include whether or not to undergo dialysis, to donate any of your tissue or organs, and/or whether to have your heart restarted (either chemically or electrically) if it ever stopped. Again, your living will can be changed at any time and again, refer to your local state laws for specific governmental details.

What is a Power of Attorney?
A power of attorney is someone you trust (usually a family member or friend, greater than 18 years of age) to make medical decisions for you if you were ever unable to yourself.  For example, let’s say you became suddenly ill and unable to breath (and speak) on your own. Your power of attorney is contacted.  If the power of attorney knows you never wanted to have a breathing tube placed, they would be able to tell the health care professionals taking care, making sure your wishes are fulfilled.  Of note, in some states, if you have a living will AND a power of attorney, the power of attorney’s opinion may trump that of your living will.  For instance, if you come through an emergency room unconscious, and your living will states you don’t want your heart restarted, but your power of attorney states you DO, then your heart would try to be restarted.  There are state specific guidelines for this appointment as well, so again contact your local state governmental agency for additional information. 

References:

American Family Physician American Academy of Family Physicians.  Sample Advance Directive Form.  Feb 1 1999 vol 59;3

Appelbaum, P. Assessment of Patients’ Competence to Consent to treatment. NEJM Nov 1, 2007. 357:18; 1834-39

familydoctor.org-Advance Directives and Do Not Resuscitate Orders

Jones S, Jones B. Advanced directives and implications in emergency departments. Br. J. Nurs. Feb 2007. 16(4):220-3.

Van Asselt D. Advance directives: prerequisites and usefulness. Z Gerontol. Geriatr.  Oct;39(5):371-5.

www.uslivingwilldirectory.com