“Do You Have an Advance Directive?”

BY MYRA KATZ, PA-C, BCPA

How many times have you been asked this question? We are typically asked any time we go to a hospital, surgical center or emergency room, and if you say “no,” you are often given a lengthy form and asked to fill it out without any explanation. If you say “yes,” usually the staff member will go on to the next question without asking for a copy or who has a copy.

So, what is an advance directive, how does it differ from a living will and why do you need this, especially if you are young and healthy?

The actual definition of an advance directive is “a written statement of a person’s wishes regarding medical treatment, often to include a living will, made to ensure those wishes are carried out should the person be unable to communicate them to a doctor” (https://www.lexico.com/en/definition/advance_directive).

Every state has its own advance directive, but typically they are very similar, and oftentimes states will accept them from other states. The vast majority of advance directives include the following information:

• Selection of a healthcare proxy
• Treatment preferences

A healthcare proxy is a person who you have chosen to represent you to the medical staff taking care of you, if and only if you are unable to communicate your wishes. This person should be chosen after a great deal of thought and conversation with the person. He or she should know if you want to have CPR (cardio pulmonary resuscitation) should your heart stop, if you want to be on a ventilator and for how long, and how aggressive (or not) you want your healthcare team to be. You should also choose two back-up people in the event that the person you choose is unable to make the decisions.

Oftentimes, many people fill out a “living will,” and this is important as it is a summary of your wishes should you become ill — for example, if you want CPR, to be intubated (if deemed medically indicated) — but it does not list a healthcare proxy.

Many of us do not complete an advance directive as there is a belief that you cannot do this without an attorney, and this is incorrect. In the vast majority of states, all you need are two people to sign the form and witness your signature. The only stipulation is that neither of these witnesses can benefit from your death or be relatives. In a handful of states, you may need to get this witnessed, but check your state’s laws. For the most part, you can download this form online and fill it out. Once it is filled out, it is important that you keep it in a place so it can be utilized if necessary. Many EMTs (those who typically respond to 911 calls) know to look on the side of the refrigerator or even in the freezer. A copy should be given to all listed on the form, to your doctor and to the hospital that you typically go to if ill.

One of the important things to do is to fill out forms on your single adult children. Once they are 18, if they become ill, the doctors cannot allow you to decide how your child’s care is managed.

And don’t forget your older adult children. Many of us have children who are still single in their 20s and 30s and they also should have advance directives.

There are a few key things to keep in mind:

Advance directives can be changed at any time. (If you move, or possibly have a falling out with a proxy, just be sure that everyone involved has the new copy.)

Another mistaken belief is that having an advance directive means that you won’t be treated if you go to a hospital or emergency room. This couldn’t be further from the truth. It means you will have the treatment that you wish; i.e., it may include having a feeding tube, being on a ventilator (breathing machine) if you can’t breathe on your own (quite common during the COVID pandemic) or receiving blood, antibiotics or even being treated with chemotherapy.

The most important thing to remember is in order for advance directives to be helpful, you need to have a conversation with your loved ones (probably a few) so they can understand what you want (and you understand what they want) and for your family to understand your wishes and why. You may not want CPR because you are fearful of possibly breaking ribs and being put on a ventilator, but your daughter wants you to live to see your granddaughter get married. You certainly don’t want to wait to have this conversation if you are in ICU in critical condition.

There is an organization called “The Conversation Project,” and I highly recommend reading about this and discussing this with your family and loved ones while you are all healthy. Things can change in a second, and we all need to be prepared.

The majority of us fear illness and death, but it will happen, and we can make it easier on our loved ones if we prepare ahead of time, and signing (and discussing the “what ifs”) is a good first step.