Life doesn’t always work out how we think it will, particularly where healthcare is concerned. That’s why it makes sense to carefully consider your medical choices ahead of time and communicate those decisions to healthcare professionals and loved ones using an advance directive.

An advance directive is a legal document specifying the medical treatments you do or do not want to receive if you cannot communicate your wishes. We’ll explain how advance directives work and discuss the most common types. We’ll also show you how to use Trustworthy to share your advance directive with the ones who matter most.

Key Takeaways

• The three most common types of advance directives are a living will, a health care power of attorney, and do-not-resuscitate (or do-not-intubate) orders.
  

• A living will and power of attorney must generally be signed and witnessed. Do-not-resuscitate and do-not-intubate orders don’t need to be.
  

• Regardless of the type of advance directive you choose, you must communicate your wishes to health professionals and loved ones.

What Is an Advance Directive and How Does it Work?

An advance directive is a legally recognized document patients can use to explain how they’d like medical decisions to be made on their behalf if they cannot decide for themselves. This enables individuals to remain in control over their medical choices if they’re incapacitated or reach a point where they can no longer communicate.

An advance directive might include a range of decisions around the types of medical procedures or emergency care you do or don’t want to happen. However, your directive might also appoint someone to make those decisions on your behalf if or when you’re unable to.

Jonathan Rosenfeld, founder of Rosenfeld Injury Lawyers explains:

“Creating an advance directive offers numerous benefits, including maintaining control over medical care decisions, even if the individual becomes unable to communicate their wishes.

It provides clarity for healthcare providers and loved ones, reduces the likelihood of family disputes, and ensures that the individual's preferences for treatment and end-of-life care are respected.”

Unlike ‌some other personal legal documentation, it’s worth noting that advance directives only apply to your healthcare decisions. They don’t affect your financial matters.

The laws around advance directives and requirements for validating them vary by state. 

Generally speaking, you should supply a valid advance directive to the relevant healthcare provider, your attorney, and any loved ones. That way, your wishes are known if anything ever happens to you or affects your ability to communicate. 

Once presented, your healthcare team is legally obligated under the U.S. Government’s Patient Self-Determination Act to honor the wishes outlined in your directive, and whenever possible, they will. 

The only times in which your healthcare wishes may not be recognized is if your directive:

• Goes against ‌a healthcare provider’s policies

• Violates accepted healthcare standards

• Goes against the healthcare provider’s conscience

To ensure this doesn’t happen, it’s advised to go over your wishes with healthcare providers before including them in your advance directive so you can rest easy knowing there won’t be any issues in the future.

Related: Understanding Full Code Advance Directives: A Comprehensive Guide

What Are the Different Types of Advance Directives?

All advance directives share the same goal: to recognize and honor your medical wishes. However, the scope of your advance directive will inevitably vary based on the type of directive you ultimately opt for.

To give you an idea of those variations, let’s run through some of the most popular types of advance directives you may want to explore.

A Living Will

Unlike your final will (which focuses on decisions that need to be made after you die), a living will is an advance directive detailing the medical decisions you’d like to make while you’re still alive. Living wills are common among those who are terminally ill.

According to David Bross, Sr. Estate Planner at Truepoint Wealth Counsel, producing a living will enables patients to take the pressure off loved ones having to make difficult decisions on their behalf. He explains:

​​”With the living will, you have the ability to express your wishes with respect to life-sustaining treatment. Without a living will, the burden is left to your healthcare agent or guardian to either consent to or remove life-sustaining treatment.

“Unless you have expressed your wishes, these individuals rarely understand your personal wishes regarding life-sustaining treatment and must guess in their decision making.”

Living wills tend to go into some detail about different types of treatments you do or do not want. For example, your living will might specify you don’t want to be subjected to dialysis or tube feedings.

Requirements vary by state. Generally speaking, a living will must be validated by a signature. It should also either be witnessed or notarized. 

Health Care Power of Attorney

Next, there’s a health care power of attorney. You’ll also often see this type of directive referred to as a “medical power of attorney” or a “durable power of attorney for health care”.

Regardless of what you choose to call it, a power of attorney is a legal document in which you appoint an individual to be your agent to make healthcare decisions if you’re unable to. That agent (or “proxy”) is then authorized to speak with your healthcare team and make decisions on your behalf.

Bross explains:

“With the healthcare power of attorney, you have the ability to choose your own agent to make healthcare decisions on your behalf should you become incapacitated or incompetent.

If you don't have a health care power of attorney in place, you leave it up to the probate court to appoint a guardian to make these decisions.”

It’s important to note that before your healthcare power of attorney is activated, your physician needs to certify that you have reached the point where you cannot make your own choices.

Likewise, you should remember that if you regain the ability to make your own medical decisions, your healthcare proxy can no longer make medical decisions for you.

Do-Not-Resuscitate (DNR) or Do-Not-Intubate (DNI) Orders

A do-not-resuscitate (DNR) order is an advance directive stipulating that, if your heart stops or you’re unable to breathe, you don’t want medical professionals to revive you. Similarly, a do-not-intubate (DNI) order is a directive dictating you do not want to receive CPR or intubation.

Unlike a living will or a power of attorney, DNR or DNI orders don’t generally have to be written or notarized. All you have to do is tell your doctor your preferences, and they will record those preferences in your medical records.

That being said, you can also include a DNR and DNI order within your living will. This will ensure you have all your bases covered.

How Should You Choose the Right Advance Directive For You?

The advance directive that’s ideal for your situation depends on the depth of wishes you’d like to pass on. 

For example, if you don’t have strong feelings about different types of medical treatments but want to ensure someone you trust is making decisions on your behalf, a medical power of attorney might be the best route.

However, if you have very specific wishes regarding procedures you’d like to avoid, a living will might be the preferable option.

When in doubt, you should discuss this with your doctor, attorney and loved ones. Just remember that it’s ultimately your decision, and you must clearly communicate it to all relevant parties to guarantee your wishes are honored.

That’s where a Family Operating System® like Trustworthy can offer enhanced support.

Trustworthy enables you to upload digital copies of critical family documents, including your advance directive. Those family documents are protected by AES 256-bit encryption, biometric authentication and security keys.

You can grant access to individuals like your loved ones, attorneys, or medical providers to ensure all relevant parties can observe your medical wishes.

Ready to learn more? Take a look at Trustworthy’s range of features.

Frequently Asked Questions

What are the Two Most Common Forms of Advance Directives?

The two most common types of advance directives are a living will and a health care power of attorney.

What are the Criteria for an Advance Directive?

The validation requirements for an advance directive vary based on the type of advance directive you’re creating and the state you live in.

Is an Advance Directive Legally Binding?

An advance directive is legally recognized, and healthcare providers are obligated to do their best to honor your wishes. However, there are some situations in which someone can override your directive.