What is an Advance Directive?

Jack stands at the door of Jill’s nursing home room, tears streaming down his face. The medical staff just finished inserting a feeding tube into Jill – an act Jack knew she didn’t want. Unfortunately, Jill couldn’t express her wishes due to advanced dementia, and she had no legal documents that expressed her wishes not to be fed by artificial means.  Jack had no choice but to sit back and watch his wife go through a procedure she didn’t want. The sad truth is that this situation could have been avoided through the use of proper advance directive. So, what is an advance directive anyway?

What is an advance directive?

An advance directive is actually a collection of documents. What that includes differs depending on your needs and wishes, along with what the law allows. However, it usually means at least a Living Will, a Power of Attorney for Healthcare and HIPAA Authorization.

The purpose of these documents is to allow you to control what happens to your health care in case you cannot speak for yourself. If certain criteria are met, your doctors must consult with your advanced directive before making decisions about your care.

Usually, what this means is that two doctors agree that an individual is terminally ill, permanently unconscious, or at the “end-stage” of a condition. Once that happens, and the individual cannot express their preferences, doctors turn to the advance directive to figure out what the individual wants.

• A Living Will determines what happens to an individual, making it, unlike a Last Will and Testament, which determines what happens to their money and possessions. A Living Will describes what healthcare providers can and cannot do to prolong your life and/or ease your pain when you cannot express those preferences yourself. For example, do you want to be placed on a ventilator if you cannot breathe on your own? Do you want a feeding tube and IVs set up, and if so, for how long? Do you want to be an organ or tissue donor?
• A Durable Power of Attorney for Healthcare lets you choose someone to make healthcare decisions for you when you cannot. They still must follow your Living Will, but they will be able to make decisions not explicitly considered by your Living Will, in accordance with the facts of the situation. In most states, there are “default surrogate consent laws” which allow family members to make treatment decisions on your behalf, but who is chosen to make these decisions and what they choose to do may not be in accordance with your wishes, as it hopefully would be with a Durable Power of Attorney.

Other documents may be part of an advance directive by law, or they may be worth including on your own volition. These include Do Not Resuscitate orders (DNRs) and Medical Orders for Life-Sustaining Treatment (MOLST), among others. You might also consider an advance directive in case of a mental health crisis.

This is a difficult subject to consider, and it always seems like it won’t be necessary. But nearly 70 percent of Americans don’t have plans in place for a worst-case scenario, which means for some of them, decisions may be made for them with which they would not agree, if they had the capacity to choose. For that reason, it is worth thinking about implementing an advance directive even if it seems unnecessary now.

Maryland Estate Planning Attorney, Andre O. McDonald, is here to help.

If you or a loved one would like more information about advance directives, please don’t hesitate to reach out to Andre O. McDonald, a knowledgeable Howard County and Montgomery County estate planning, special needs planning, Medicaid planning and veterans pension planning attorney at (443) 741-1088 to schedule a consultation.

DISCLAIMER: THE INFORMATION POSTED ON THIS BLOG IS INTENDED FOR EDUCATIONAL PURPOSES ONLY AND IS NOT INTENDED TO CONVEY LEGAL OR TAX ADVICE.