How Much Do You Know About Advance Directives?

A regular will is a document that states how you want your estate handled after your death, according to the National Hospice and Palliative Care Organization (NHPCO). It takes effect after you die. A living will is a document that states what kind of medical care you want (feeding tubes or artificial breathing, for example) if you are too ill to make that decision. It does not become effective unless you are terminally ill, with no chance of recovery, and it does not allow you to name someone to make medical decisions for you. A durable power of attorney is another kind of advance directive, in which you name a person who will make medical decisions for you if you are unable to make them yourself. A third kind of advance directive is a do not resuscitate order, which means you do not want medical staff to try to revive you if your heart stops beating or if you stop breathing.

The person can be anyone you choose—spouse, son, daughter or friend. The person does not have to be a lawyer. The durable power of attorney document—also called a health care proxy or health care surrogate—can include specific instructions about medical treatment you want or don't want, the NHPCO says. This document is valid indefinitely, unless it lists a specific termination date, is revoked by you or the person you designate becomes incompetent. The person you select can only make health care decisions on your behalf if your doctor declares you incompetent.

In addition to any restrictions you may place on the person with medical power of attorney, in general this person is not allowed to grant consent to have you committed to a mental institution or to allow convulsive treatment, psychosurgery or abortion. The person also cannot consent to allow your comfort to be neglected.

It depends on the state in which you live. Some state laws favor one document over the other. Some state laws allow you to have both documents, or to combine the documents into one that includes both your medical wishes and the name of the person who will act on your behalf, the NHPCO says.

No state requires an advance directive. It is your decision to have one.

Just as a regular will can be changed, an advance directive can be modified or even canceled, if you change your mind. Appropriate state law must be followed, and you should give copies of the new document to your doctor and others to whom you gave the original paperwork. If you're in the hospital and you don't have time to make the changes in writing, you can make changes orally, if you state your wishes directly to your doctor or to a family member or friend, the NHPCO says. Make sure they understand exactly what you want to happen. Usually, wishes that are made in person will be followed in place of the ones made earlier in writing. To change your advance directive, whether in writing or orally, you must be of "sound mind," which means you must be able to think rationally and speak clearly.

If you travel to or vacation in another state, you do not need a separate advance directive for that state. If you move, however, you should prepare a new advance directive to meet the laws of the new state. If you spend a lot of time in another state, you should consider getting a second advance directive so that you are on record in both places.

The card should also state where the advance directive is located and the name of the person who will act on your behalf, if you have named one. You should give copies of your advance directive to your doctor, hospital, nursing facility and person acting on your behalf. You should let your lawyer or a family member know you have an advance directive and where it is located. Keep it in a safe but easily accessible place. You can also keep your advance directive on file at the U.S. Living Will Registry website (http://www.uslivingwillregistry.com/). Registration is free, and the information is accessible only to health care providers.

You can write your own, but special forms may make the task easier. Keep in mind that each state has its own requirements about advance directives. You can obtain a copy of the form for your state from the NHPCO website (www.partnershipforcaring.org). If you don't use one of those forms, you can use a form provided by your doctor; obtain a form from your state senator's or representative's office; have your lawyer draw up a form; use computer software for legal documents; or simply write down your wishes by yourself. If you do it yourself, it's a good idea to have your doctor or lawyer review the document to make sure it meets your state's requirements.

If you wait until you are hospitalized for an illness, you may become too ill to complete an advance directive. And that's when it's most important to have one. The best time to prepare an advance directive is when you are healthy and able to think through what care you want—or don't want.

Standard advance directive forms do use vague wording, stating only that you would not want "heroic" or "artificial" treatment if you are clearly "dying." It's best to provide as much specific information as possible about the care you want or don't want. Discuss with your doctor and family different medical situations and what you want to happen. If you don't want artificial resuscitation or if you don't want be put on a ventilator, for example, put that on the form. Although these issues may be uncomfortable or difficult to think about, your answers will help guide your family and caregivers.