Advance Directives

You have the right to make decisions about your healthcare. This includes the right to accept or refuse medical or surgical treatment. But if you become seriously ill, you may lose the ability to participate in decision-making about your own treatment. Fortunately, you have the right to plan and direct the types of healthcare you wish to receive in the future. You can do this by making an advance directive. An advance directive gives you a voice in decisions about your medical care when you are unconscious or too ill to communicate.

The following are some frequently asked questions regarding advance directives:

An advance directive is a document that indicates, in writing, your choices about the treatments you want or do not want or about who will make healthcare decisions for you if you become incapacitated and cannot express your wishes. Traditionally, there are two main kinds of advance directives: the living will and the Durable Power of Attorney for Healthcare. California also allows the use of a POLST (Physician's Orders For Life-Sustaining Treatment). An advance directive allows you to express your personal wishes and is based upon your own beliefs and values. When you make an advance directive, you have the opportunity to consider issues such as end of life care, being kept alive their machines, being independent, and quality of life.

If you are 18 years of age or older and of "sound mind," you can make an advance directive.

An advance directive speaks for you when you are unable to do so. Because it tells others the care and treatments you do or do not want and/or who will make healthcare decisions for you when you cannot express your wishes, it may relieve your family from the burden of guessing what you would want. Providing such guidance may also prevent painful family arguments about how you would want to be treated.

You do not need a lawyer to complete these forms. However, for a Living Will or Durable Power of Attorney for Healthcare, two people must witness your signature, or it must be acknowledged before a notary public. The forms themselves describe who may or may not be a witness. For a POLST, while you can complete parts of it by yourself, other parts require your physician's input as well.

A living will is a written statement in which you specify what kind of healthcare you do or do not want to receive. It can act as a guide for those who may need to make your medical decisions. A living will allows you to make decisions regarding treatment or machines that keep your heart, lungs or kidneys functioning when they are unable to function on their own.

Although you may write your living will on your own, it is best to inform your family, close friends and physician of your wishes.

The power of attorney for healthcare is a form that allows you to appoint another person (a "healthcare agent") to make healthcare decisions for you if you are not capable of making them for yourself. When you complete this form, you give authority to your healthcare agent to make a wide range of decisions for you, such as whether or not you should have an operation, receive certain medications or be placed on life support. In some areas of healthcare, your healthcare agent is not allowed to make decisions for you unless you give him or her specific authority in these areas when you complete the form. These areas are listed on the form.

You can also include specific instructions about the type of treatments you want or do not want (such as surgery or tube feedings) when you complete the form. A power of attorney for healthcare goes in effect only when two physicians, or a physician and a psychologist, agree in writing that you can no longer understand your treatment options or express your wishes to others.

A Physician's Order for Life-Sustaining Treatment (POLST) is a physician's order that outlines a plan of care reflecting a patient's wishes concerning care at life's end. Unlike traditional physician's orders, POLST is not bound to a particular site. Rather, the orders contained within a POLST must be honored across care settings and hence may be used by EMT's, physicians, nurse's in the emergency department, hospitals, nursing facilities, and so forth. In short, a POLST allows physicians order regarding end of life care to travel with a patient as the patient moves between home, the hospital, long-term care facilities, etc.

Because your healthcare agent will make decisions for you based upon what he or she knows about you and thinks is best for you, it is important to choose someone who knows you well and to discuss your treatment preferences with him or her. You should choose someone who is willing to make the decisions you request in your advance directive. Your agent cannot be your doctor.

It is generally a good idea to have all three because doing so provides greater guidance for ensuring that your values and preferences will be known in the circumstance when you cannot speak for yourself. However, there is no requirement that you have all three.

You can cancel or replace a living will or a power of attorney for healthcare at any time. The different ways you can do this are explained on the forms you complete when you make a living will or appoint a power of attorney for healthcare. A POLST can be changed as long as you have the capacity to request alternate treatments. If you lack decision making capacity, your surrogate may also request a change in conjunction with your physician.

You will receive medical care regardless of whether or not you have an advance directive. However, there may be a greater chance you will receive the types of care and treatments you want if you have an advance directive. If you cannot speak for yourself and do not have an advance directive, a physician will generally look to your family, friends, or clergy for decisions about your care. If the medical center is unable to locate any family to act on your behalf, they may ask the courts to appoint a person (a guardian) who will make decisions for you. An ethics consultation may be offered to help determine your goals and values in the absence of an advance directive.

You should make several copies of you advance directive. A legible copy of an advance directive is acceptable. Find a safe place where you and others can easily find your copy. (Do not keep it in a safe deposit box.) Your family members and your lawyer, if you have one, should know you have made an advance directive and have a copy. You should also ask your physician to make your advance directive part of your permanent medical record. Without a copy of your advance directive, it cannot be used as a guide for your treatment.

Cedars-Sinai offers a free class, on the second Tuesday of the month, to help you complete your Advance Healthcare Directive form and guide your loved ones and caregivers in determining the treatment you want.

See more information on the Advance Care Planning class (PDF) at Cedars-Sinai.

Your physician or other healthcare providers can help you understand your health needs and the options for treating these needs.

Also, the Supportive Care Medicine team at Cedars-Sinai may also be able to assist in answering Advance Healthcare Directive questions. Please visit the Supportive Care Medicine program for more information about this multi-disciplinary consult service.

Have Questions or Need Help?

Call us or send a message to the Healthcare Ethics team. You can also have us call you back at your convenience.

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