What is an advance health care directive and why is it important to medical care?

An advance health care directive is a legal document that allows you to name the person who will make medical decisions for you in the event you are unable to do so for yourself. The health care directive also guides that person on what your medical wishes are, so that he or she may make decisions with better understanding and confidence.

Are there other names for Advanced Health Care Directives?

Yes. “Advance health care directives” are also known as “health care proxies”, “health care durable powers of attorney”, “living will” or simply “health care directives”. No matter what name is used, they all share the same common goal: identifying who can make medical decisions for you, and what your wishes are.

Why is it important to have a Health Care Directive?

While it is often uncomfortable to think about your own end-of-life care, the peace of mind you gain with a health care directive ultimately provides enormous comfort for you and your loved ones. Remember, these documents are only utilized in a scenario where you are unable to make medical decisions for yourself.

A health care directive makes medical decision-making and medical care easier for yourself and your loved ones. Please consider the two following scenarios:

Who will the doctor consult with if I am unable to make my own medical decisions?

If you are unable to understand your medical condition or make medical decisions for yourself, the doctors are faced with determining who they can turn to who is authorized to make medical decisions on your behalf.

Scenario 1: You don’t have a health care directive.
Without a medical health care directive, your medical team will only consult with your next of kin. Furthermore, only your immediate next of kin will be allowed to see you should you be hospitalized.

While this may be sufficient for many individuals, there is a possibility that you are not comfortable with this. What if you are in a serious long-term relationship but are not married? Would you prefer your parents/siblings make decisions for you? Or your significant other who is not yet your spouse? If you are not married to your partner, the medical professionals will be legally obligated to consult with your blood relatives over your long-term partner.

Perhaps you have had a falling out with your immediate biological family, or your family lives a considerable distance away, and you would prefer a close friend to have the authority to speak with the medical professionals on your behalf.

Scenario 2: You do have a health care directive.
With a health care directive, your health care team will only consult with whomever you have identified as the person(s) explicitly authorized to make your medical decisions in the event you can’t make those decisions for yourself.

What are the parts of an Advanced Health Care Directive?

There are multiple components to a health care directive. They include the following:
– The identification of the person(s) you are authorizing to make medical decisions for you, in the event that you can’t speak for yourself. This will also include the type of decision-making authority you are giving to this person.
– The identification of your medical wishes. This will include what type of life support treatment you would prefer to receive, any limitations on medical treatment preferences (example: you can specify that you do not approve of the use of medical devices made from animals). You can also specify what type of organ donation you prefer and are comfortable with.
– Signatures, both your own, and your witnesses.

How do I state my wishes for my medical care in an advance health care directive?

Once you identify who you want the doctors to consult with, the next step is to make it clear what your wishes are for your medical care.
Express your medical care wishes in broad terms
While it is impossible to predict and plan for every possible future event, it helps to think of these in big, broad terms.
For example: if you were unconscious and the doctors knew there was little to no likelihood that you would regain consciousness, would you prefer to stay on life support indefinitely or be allowed to pass peacefully?
The goal here is not to give detailed instructions for every possible future scenario, but to give a framework for what your wishes are for your own medical care; and what values you hold when making your own medical decisions.
Health care directives can and will address the extent of life-prolonging treatment you are comfortable with, what type of medical procedures you approve of, and organ donation.

How do I know that my wishes in an advance health care directive will be carried out?

Your health care team must abide by your wishes according to the Patient Self-Determination Act (PSDA) of 1990, which requires hospitals, skilled nursing facilities, home health agencies, hospice programs, and Health Maintenance Organizations (HMOs) to:
1) Find out if patients have an advance directive
2) Recognize the advance directive and honor the patient’s wishes

Can I change my mind on my health care directive at any time?

Yes. You can change or cancel your advance directive anytime as long as you can communicate your wishes. If you want to change the person that you want to make your health care decisions, you must sign a statement or tell the doctor in charge of your care.

Where should I keep my advance directive?

Make sure you give your advance directive to the following people:
1. The person you chose to make your medical decisions for you in the event you can’t make them yourself. This person is your health care agent.
2. Give a copy to your alternate health care agent.
3. Give a copy to your doctor for your medical records.
4. Tell close family and friends where you keep a copy.
5. If you have to go to the hospital, give the staff there a copy, too.
It is advisable to keep a list of everyone you gave a copy to, in case you decide to change your advance health care directive.

Closing Thoughts

We want to acknowledge once again that we understand how difficult it is to plan for these scenarios.To help make it easier, you suggest you try this technique:

Imagine what your loved ones will feel if they don’t have clear guidance on medical decisions that you would make for yourself.

As we can attest to personally, making a medical decision for a loved one without guidance is very stressful and emotional. If your health care agent had the benefit of having your own written words to turn to regarding your wishes, this can bring tremendous comfort to your loved ones during a very emotional and stressful situation.

Lastly, please bear in mind that without appointing an agent and leaving clear wishes, it is possible that your next of kin will disagree on what decisions to make, thus prolonging the implementation of any medical care decisions.

Some notable cases on this topic include Terri Schiavo, Juan Fernando Romero, and Nancy Cruzan. These are all cases involving the question of whether or not life extending treatment or life support should be terminated, who in these cases was the proper person to make such a decision, and what was the patient’s wishes.

Our estate planning practice provides advice on health care directives.

If you have questions about your own health care directive and how to ensure that your medical wishes are followed, please give us a call at (408) 413-1200 or send an email to [email protected] and we would be glad to schedule a consultation with you.

Advance Care Directive Resources

Where to find California Advance Care Directive Forms
https://oag.ca.gov/sites/all/files/agweb/pdfs/consumers/ProbateCodeAdvancedHealthCareDirectiveForm-fillable.pdf