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Understanding advance directives and their different uses

When thinking about end-of-life planning, people often worry about the medical care they might need in the future. And while we can’t know if or when we’ll need vital care, there are some possibilities that we can plan for — such as becoming ill and not being able to communicate our health care wishes. Advance directives are legal documents you can draw up in advance to provide instructions for your care in case you become incapacitated. 

There can be confusion about the different types of advance directives, as their names and what they cover can vary from state to state. Below we’ll explain the differences so you have the right legal documentation in place. 

What’s an advance directive? 

Advance directives are legal documents that take effect if you’re unable to make decisions due to incapacity or illness. There are a number of different types of advance directives, which most commonly include a living will and a health care power of attorney.

Distinctions between different advance directives

Understanding the difference between the various advance directives can be confusing, for a few reasons. First, there are no exact rules for what you should include in an advance directive. This means that the instructions outlined in the document can differ from person to person. 

Second, different states have their own laws on what is considered an advance directive, and they can also refer to these documents by different names. You can find the exact forms and rules for your state on the AARP website

In general, the following distinctions are made between these documents:

Living will

A living will is a type of advance directive. It plays a role if you become unable to make choices or decisions on your own. In that event, a living will dictates what measures could be used to prolong your life. Doctors will refer to your living will to find instructions on which kinds of life-sustaining treatment to provide or withhold. 

Living will vs. Health care power of attorney

A health care power of attorney (sometimes called a health care proxy) and a living will are usually two separate documents. While a living will contains your wishes for end-of-life medical care, a health care power of attorney legally assigns someone to act as your agent for medical decisions in the event that you become incapacitated. 

Health care power of attorney vs. durable power of attorney (for finances)

Another type of power of attorney is specifically related to your financial and legal decisions if you become incapacitated. While a health care power of attorney legally assigns someone to act as your agent for medical decisions, a durable power of attorney legally assigns someone to act as your agent for financial and legal decisions. 

A durable power of attorney is used to permit someone else to manage all of your financial affairs if you become incapacitated. A durable power of attorney and a health care power of attorney are usually two separate documents. 

Other documents determining medical care

There are other documents that aren’t technically advance directives but may be part of your health care planning.

  • Documentation containing your instructions for organ donation 
  • A POLST (Physician Orders for Life-Sustaining Treatment) form is typically used when you’ve already been diagnosed with a serious illness and specifies which treatment you prefer if you’re unable to communicate your wishes. POLSTs aren’t available in all states, and the forms required vary from state to state.  
  • A DNR (Do-Not-Resuscitate) order stipulates that doctors shouldn’t attempt to revive you if your heart or your breathing stops.
  • A DNI (Do-Not-Intubate) order instructs doctors to not use a breathing tube if you’re in a life-threatening situation

To create a DNR or DNI order, ask your physician to document your preferences in your health care records. If you’re admitted to a new medical facility, it’s a good idea to make sure that your DNR and/or DNI order is recorded.

Why create an advance directive?

None of us want to think about being seriously ill, but it can be a comfort to know that if it does happen, we’ll be treated according to our wishes. Creating an advance directive such as a living will gives us a chance to think properly about our options and make decisions in a calm and measured way before the need arises. It also means that our loved ones won’t be tasked with the burden of making medical decisions on our behalf if we become incapacitated.

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