What Is an Advance Directive (and Why Do You Need One)?

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Sometimes known as a living will or medical directive, an advance directive is a legal document that spells out your health care wishes if you are unable to speak for yourself. Though many people associate it with older adults, an advance directive has nothing to do with age: It goes into effect only when you’re no longer able to articulate your own health decisions, whether by illness or incapacity—no matter how old you are.

Despite the importance of such paperwork, fewer than half of Americans older than 65 have an advance directive, and only 7 percent of those age 18 to 29 have one, according to a Consumer Reports National Research Center survey.

What goes into an advance directive

There are two main elements to any advance directive: a living will and a durable power of attorney for health care issues.

A living will is a document that tells doctors, medical professionals and family which treatments you’d want if you’re dying, permanently unconscious or otherwise unable to make decisions about emergency care. Rather than write paragraphs of possible scenarios, you can simply chose from a standard list of procedures which you’d want performed, which you wouldn’t, and when your choices apply.

Health care proxy, or health care power of attorney, is a legal document that names a trusted family member or friend to make medical decisions for you if, for any reason, you’re unable to do so. (Heads up: The health care proxy is also known as a health care power of attorney—but this is different than the power of attorney that allows someone to make legal and financial decisions on your behalf. You’ll need both documents, to cover all of your bases.)

The advance directive lists directions to your proxy about the full range of care that you want, but not all situations can be anticipated and some may require your family member or friend (acting as your health care agent) to make a judgement about your likely wishes. For that reason, it’s important to have a thorough discussion with your proxy ahead of time, to make sure they understand your healthcare wishes.

How to establish an advance directive

Most states in the U.S. have specific forms that allow health professionals to easily follow your directives. These documents even govern your desires related to life-sustaining treatment like CPR, ventilator use, tube feeding or comfort care. Some states combine the living will and health care proxy into one document, so it’s important when you download your state’s form to take note of what you’ll need. Find your state’s forms here:

You don’t need a lawyer to make it official. The advance directive becomes legally valid as soon as you sign in front of the necessary witnesses listed on the forms.

An advance care directive doesn’t have to be set in stone. You can adjust your wishes at any time, by signing and dating any minor alterations or revoking your existing advance directive and creating a new one.

Keep in mind that an advance directive isn’t much help if no one knows about it or where to find it during a health crisis. Make sure to share copies and discuss any changes as they happen with your family, physician and any other appropriate people, like assisted living staff or close friends.

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