Who among us relishes the thought of lying incapacitated in a hospital room due to health issues, unable to communicate with those we love or even to our doctors? That is a grim prospect that some will likely face at some point in their lives. People who are dying a slow death--and in a lot of pain--may not want to be resuscitated if their heartbeat were to stop, yet if they have not expressed this desire in a legal written form (an advance directive) prior to the event, then it will not be their decision to make.
Advance Directives Defined
An advance directive is a written legal document that outlines the type of end-of-life medical care you desire in the event of certain medical occurrences, as well as your incapacitation to communicate those desires verbally or physically. The document also reflects the name of the individual being authorized to make medical decisions on your behalf in such a circumstance.
Health Issues That Prompt Advance Directives
Medical conditions that are likely to prompt someone to create an advance directive include, but are not limited to, terminal cancers, organ failures and advanced diabetes. Serious or terminal illnesses like those mentioned above generally produce some specific and anticipated health complications at some point. These anticipated complications will eventually necessitate the need for things like breathing machines, dialysis or feeding tubes in order to ensure continued life. Therefore, the advance directive's purpose is to afford the patient the opportunity to have a voice in that treatment (or lack thereof) in advance of the circumstance anticipated.
Comparison of End-of Care Documents
Several end-of-care options exist and are called by different names (advance directive, living will, proxy and durable power of attorney). Therefore, it is good to understand each type in order to know if the advance directive is the right medical document for you. While the advance directive can detail the types of end-of-life care you desire (i.e., no resuscitation if your heartbeat stops), as well as who you want to make such decisions during your incapacitation (spouse, adult child, doctor), it really is more for those who are at the end of their lives and have been apprised by their doctor that incapacitation will eventually happen and what form to expect it to take. For example, a seizure, heartbeat cessation or coma.
Living Will vs. Advance Directive
The living will, another end-of-care document, is geared more toward outlining basic medical preferences--which could be as minor as stating your preferred medications, your position on antibiotics (you want them or you don't and which kinds) or any other number of preferences (no to resuscitation, yes to feeding tubes). Unlike the advance directive, which is created with an anticipated incapacitation due to a serious health concern, the living will is created only as a precaution against the possibility of incapacitation. No known health issue may even exist at the time of its creation.
Proxy and Durable Power of Attorney vs. Advance Directive
Two other end-of-care options are a health care proxy and a durable power of attorney. These two are geared more toward giving a designated individual (family member, friend, doctor) the ability to request, or refuse, any treatments needed during an anticipated--but only possible--limited time of incapacitation. These options are generally chosen by individuals about to undergo serious surgery but do not really expect any complications; they are just taking precautions of being possibly incapacitated due to surgery risks.
The durable power of attorney has one additional benefit: it provides the patient's designated decision maker to make any financial or estate decisions in the event of the patient's medical incapacitation.
History
Although an attorney named Luis Kutner introduced the idea of a living will back in 1967, it wasn't until 1976 that the first state (California) passed a bill in support of living wills--thanks to Senator Barry Keene. Three prior legislative attempts, in Florida in 1968 and then again in 1973 (both by a doctor in the state named Walter Sackett) and one attempt later in California in 1974 by Senator Barry Keene, had been met with resistance and failed to pass. By 1992, all the states had passed bills supporting advance directive options.
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