Advance directives

[Sonia]

Health care advance directives are legal documents that communicate a person’s wishes about health care decisions in the event the person becomes incapable of making health care decisions. There are two basic kinds of advance directives: living wills and health care powers of attorney. (See also Overview of Legal and Ethical Issues in Health Care.)

A living will expresses, in advance, a person’s instructions or preferences about future medical treatments, particularly end-of-life care, in the event the person loses capacity to make health care decisions.
A health care power of attorney appoints a person (called a health care agent or proxy, health care representative, or other name depending on the state) to make decisions for the person (the principal) in the event of incapacity (temporary or permanent) to make health care decisions.

Normally, people communicate their wishes directly to their doctors. But when a person no longer has the capacity to make or communicate a health care decision, another way to make and communicate a decision is needed. That is the role advance directives play. If no advance directive has been prepared, someone else recognized by state law or appointed by a court may be called on to make health care decisions. Many states authorize default surrogate decision makers, usually next of kin when the patient lacks capacity and has not appointed a health care agent.
When state law does not authorize a default surrogate decision maker, doctors and hospitals still usually turn to next of kin, although the extent of their legal authority becomes less clear. In the rare event that the issue is referred to a court, courts generally prefer to name a family member as guardian or conservator to make health care decisions, but they may also turn to a friend or a stranger to direct care. A health care power of attorney (and a living will if it provides useful guidance) eliminates almost any need for the courts to get involved and helps ensure that the person’s health care decisions will be respected.

[Dave Paprocki]

Advance directives are legal documents that extend a person

[Zipporah Schumaker]

another term for living will