Few of us want to think about what would happen if we or a loved one were in a devastating accident or incapacitated by advanced illness. Yet it’s recommended that everyone over the age of 18 have a plan in the event of a sudden illness or injury. Advance directives are an important part of this plan.
Advance care planning is a four-step process that helps you plan for future medical care in case you are ever unable to make your own medical decisions. An important element of creating a plan is naming a health care agent.
Your health care agent is the person you designate to make decisions about your care if you are unable to do so. Your agent should be:
There are many types of advance directive documents. Here are four common ones:
Health Care Proxy is the written document that designates a person as your health care agent when a doctor determines that you have lost capacity to make decisions for yourself. It also allows written statements about desired medical treatment decisions in advance. It is a good idea for everyone over the age of 18 to have one. Health care proxies can be designated for temporary situations (i.e., surgeries or sudden illness) or for permanent situations (i.e., you are in a coma or if you develop dementia or Alzheimer’s). There is a simple form you can fill out yourself.
A Living Will is a written document that allows you to state your wishes for different medical treatments in advance. Unlike a health care proxy, it does not designate someone you trust to make treatment decisions on your behalf, but can serve as evidence of your wishes as long as the directives are stated clearly and should be updated regularly.¹ You should discuss your medical care options with your doctor including the pros and cons of prolonged medical treatment. This will help you make a decision that is right for you. Examples of medical treatments in a living will include mechanical respiration (machines that breathe for you), tube feeding, hydration/fluids and pain relief/comfort care. There is a form you can fill out yourself. You can have both a health care proxy and a living will.
The DNR—Do Not Resuscitate is a medical order issued by a doctor, at your request. The DNR tells medical staff not to provide CPR (chest compressions) if your heart stops. A DNR order does not mean the withholding of all medical care, only CPR. DNR instructions can also be made known in a health care proxy or a living will. It is very important to discuss DNR with your doctor.
The DNI—Do Not Intubate is a medical order issued by a doctor, at your request. It specifies whether a breathing tube can be inserted in your throat. DNI instructions can also be made known in a health care proxy or a living will. Talk with your doctor about when intubation might be used and to see if it is something you would want.
¹A living will is not formally recognized under New York law, but some courts have allowed a living will to serve as evidence of a patient’s wishes if the directives were clear.