Advance Directives Explained: What You Need to Know

Introduction

If 2020 taught us anything, it’s that we never know when we’ll get sick or die. Only around 30% of Americans had advance directives back then. Shockingly, despite what millions of us experienced during COVID-19, that number hasn’t increased. In fact, only about 32% of Americans have even verbally shared their end-of-life wishes with loved ones.

I want to talk a little more about the statistics. About 30% of Americans have an advance directive. A higher percentage have a chronic illness or are over 65. But what about the healthy population from 18 to 64? About 33% of deaths in the US happen before age 69. But, less than 30% of that age group have a living will.

Advance care planning proves essential in preparing for the future. It involves making decisions about the care you would want to receive if you become unable to speak for yourself.

Just last week, I was conducting research for a resource I am working on with links to every state’s advance care planning guidelines and forms. Several states have almost nothing on their government websites. For many others that did, I found the information buried under hard-to-find elder-care sections. No wonder few people have thought about their end-of-life wishes. There is so little information out there.

What is Advance Care Planning?

Advance care planning is the process of thinking about and writing down your healthcare preferences. This is in case you become unable to make those decisions. Most state-specific forms are limited to specifying your wishes about basic treatments such as intubation, ventilation, and resuscitation. However, it is important to be aware that you can and should plan down to the tiniest details for your end-of-life care.

Most people will lead you to believe this is about whether or not you are on machines at the end of your life. Most estate planning attorneys will offer you a form with four questions on it. But what about the rest? If you had the choice, where would you want to be? What music would you like? What visitors would you want and not want? These are all things you can plan for. Death comes for all of us. It is a natural part of life, a rite of passage. It can be very powerful to know that you will be the architect of that rite.

Why is Advance Care Planning Important?

Advance Care Planning ensures that others know and respect your healthcare preferences. If you do not have an advance directive, the wrong people could end up in charge of your medical care. All states have a hierarchy of decision-makers for you if you are unable to speak for yourself. In most states, your surviving spouse comes first. Then come your adult children. Then your parents, siblings, grandchildren, and grandparents. Again, each state is different, so you will want to check your state’s laws. There are many reasons why leaving your decisions to the hierarchy could be a problem.

Let’s imagine a few scenarios:

• You are married, yet you have recently become separated from your spouse. However, you haven’t yet made your split legal. Without an advance directive, your spouse can likely, depending on your state, make your medical decisions.
• You’re not married, you don’t have adult children, and you’re estranged from your parents. Maybe you’re in a relationship, but because you aren’t married, your parents will make your medical decisions. They will do this despite having no relationship with you.
• You aren’t married and have no family at all. Medical providers may make decisions based on standard practices rather than your specific personal wishes.

Another important reason is so your loved ones are not left guessing what you would want for yourself. As someone who had to make my father’s care decisions and plans when he was dying, I can tell you it was one of the hardest things I have had to do. Even though I knew I was making the right decisions, I still think back and question my choices. I would have much rather spent the time I had left with him actually being with him instead of dealing with logistics.

Types of Advance Directives

Each state has its own specific guidelines for what documents are included in an advance directive. You will want to check with your state to find out what those are. The most common are:

• Living Will: Specifies the types of medical treatment you want or do not want.
• Medical Power of Attorney or Proxy: Appoints someone to make healthcare decisions on your behalf.
• Do Not Resuscitate (DNR) Order: Indicates that you do not want CPR if your heart stops.
• Mental Health Care Power of Attorney. Appoints someone to make mental healthcare decisions on your behalf if you are found to be mentally incapable. It is not limited to individuals with mental illness but also includes dementia, Alzheimer’s disease, and other brain-altering injuries or illnesses.
• POLST or MOLST. Each state has a different name; they are portable medical orders written by your physician. At this time, these orders are only available to the terminally ill or elderly.

How to Start the Conversation

Discussing advance care planning with loved ones can be challenging. Here are some tips to get started:

• Choose the right time: Look for natural opportunities to bring up the topic, such as after a medical checkup or a relevant news story.
• Be honest and clear: Share your thoughts and feelings openly.
• Listen: Encourage your loved ones to share their views and concerns.

Download my Free Top 8 Questions to Discuss with Your Loved Ones About End-of-Life Care.

Overcoming Common Barriers

Many people hesitate to create an advance care plan due to fear, cultural taboos, or the belief that it’s only for the elderly. It’s essential to recognize that Advance Care Planning is about planning for the unexpected and ensuring your wishes are respected at any age.

Legal and Medical Implications

Advance directives are legally recognized documents. However, it may come as a surprise to learn that they may not be legally binding in all situations. It’s crucial to discuss your directives with your healthcare provider. You need to ensure that they understand and will adhere to your wishes.

The Emotional Benefits of Advance Care Planning

Creating an advance care plan can provide peace of mind for you and your loved ones. It reduces anxiety about the future. It ensures that your healthcare preferences are known and respected.

Practical Steps to Create an Advance Care Plan

1. Reflect on your values: Consider what is most important to you in terms of quality of life and medical treatment.
2. Discuss your wishes: Talk with your family, friends, and healthcare providers.
3. Document your preferences: Use legal forms to record your wishes.
4. Review and update regularly: Ensure your plan reflects any changes in your preferences or health status.

Conclusion

Advance care planning is a vital step in ensuring that your healthcare preferences are known and respected. 70% of Americans will be unable to make their own decisions at end of life. By taking the time to create an advance care plan, you can provide peace of mind for yourself and your loved ones.