Advance Directives

Advance directives are legally recognized expressions by people about how they want certain aspects of medical care to be done for or about them in the event of disability or incompetence. Advance directives are usually written documents that may need to conform to specific state laws. Verbal expressions of intent may be permitted in some states, but they may create ambiguity, leading to conflicts between parties and to costly litigation. The purpose of advance directive documents is to provide a legal enforceable basis for exercising the specific intentions of people, while they are still alive, about the medical care services they wish to receive. Specifically, they provide instructions about whether heroic measures should be taken to keep them alive in the event of a heart [Page 7]attack or life-threatening accident; whether they wish to have artificial life support devices such as respirators and nutrition/hydration tubes; whether they want antibiotics; the conditions for which they may want treatment; and who is delegated, in the event of incompetence, to make medical care decisions on their behalf. Advance directives also may specify people's wishes regarding participation in medical research such as who may make research decisions for them or the types of research in which they are willing to participate.

Advance directives involve specific documents, including living wills, health care surrogates/durable powers of attorney for health care, and “do not resuscitate” orders. In discussing executed legal documents, we refer to the person signing the documents as “Party A” and to persons who may have authority delegated under these documents as “Party B,” “Party C,” and so on. These documents should be discussed among adult family members, and persons should consider executing them as soon as they are legally competent, usually 18 years of age. The documents can always be changed. But if they are not in place, controversy and even litigation can erupt to destroy the fabric of families and loved ones. Each type of advance directive document carries a different kind of legal weight and purpose. Many states require separate documents to accomplish each task.