Aging with Dignity Toolkit: Health Care Advance Directives

Planning is the key to aging with dignity.  In my “Aging with Dignity Toolkit,” you can learn about certain planning tools that you can use to control how your person and your property are managed as you age.

Following is a discussion of a documents classified as health care advance directives.  Many people are aware of the need to plan for their financial future.  Something that is equally as important (but perhaps less talked about) is the need to plan for your future healthcare needs.  Conversations about death, dying, and end-of-life care are uncomfortable and unpleasant, which is probably why most people avoid these conversations.  However, a small amount of planning can help ensure that your wishes surrounding your care are respected, even if you become unable to communicate those wishes on your own .

What Are Advance Directives?

Advance Directives are the tools that you use in order to direct others as to how to care for you in the event that you become unable to communicate your wishes.  There are two main types utilized in New York: (1) health care proxies; and (2) living wills.  Each is described further below; in general, it is a good idea have both a healthcare proxy and a living will in place.

Health Care Proxies

A health care proxy is an individual (or individuals) that you appoint to make decisions about your healthcare in the event that you are unable to make the decisions yourself.  You can appoint a health care proxy by filling out a form and having it signed and witnessed.

In some instances, you may want to appoint more than one proxy.  If you do so, it is usually a good idea to name one of the individuals as the “lead proxy” so that they have the final say in a decision if there is a dispute.  Remember — your proxy is supposed to make decisions in accordance with what you would want – not what the proxy wants.  Make sure your lead proxy is a person who is likely to know what you would want and likely to advocate for your wishes above his or her own wishes.

You can find a sample health care proxy form, along with instructions on how to complete the form here: https://www.health.ny.gov/forms/doh-1430.pdf

Living Wills

Living wills allow you to spell out specific wishes about your care.  For example, you can specify in a living will whether you would like to receive artificial hydration and nutrition, antibiotics, or other extraordinary measures.

You can find a sample living will here: http://www.nysba.org/WorkArea/DownloadAsset.aspx?id=26506

What do I do with My Advance Directive After it is Completed?

After you have completed your Advanced Directive (health care proxy, living will, or both) you should sign the documents in the presence of two witnesses.  The witnesses must also sign the documents.  You should you provide a copies of the completed documents to all of your healthcare providers so that they can put them in your medical record.  You should also provide a copy of the documents to a few trusted loved ones.  Additionally, you should keep a copy in “wallet card” format on your person. If you want to revoke or modify the documents later, you will have to let everyone who has a copy know, so it’s a good idea to keep track of who you have given copies.

What if I Change my Mind?

Some people fear executing advance directives because they are worried the documents are permanent or will cause doctors to withhold treatment for routine medical care.  Remember, advance directives only come into play when you are unable to make decisions about your own healthcare.  If you are able to make your own decisions they will override the advance directives.  For example, if you say in your living will that you do not want antibiotics if you are in a vegetative state, this will not prevent your primary doctor from giving you antibiotics for a minor infection when you are otherwise healthy.  Further, advance directives can be freely revoked or modified by you at any time.  In fact, you should revisit these documents at regular intervals and change them as warranted by changes in your wishes.

Conclusion

Advance directives are an important part of planning for your future, regardless of your age.  Taking the time to create a health care proxy and living will can help you maintain autonomy and control over your medical care even if you become unable to express your healthcare wishes.