What is an Advanced Healthcare Directive?

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“I don’t have an advanced directive because I have an illness, I have an advance directive because I have a family.” Ira Byock, MD.

An Advanced Healthcare Directive encompasses two kinds of legal documentation, Living Will and Durable Power of Attorney for Health Care.

This document is important to help individuals and their families understand what matters most to them when faced with a medical crisis or serious illness. It will explain and describe your healthcare and medical wishes if you are unable to communicate them yourself. It will help guide your healthcare providers in your care so that your wishes will be honored. By completing an advanced healthcare directive your healthcare team will have transparent documentation of your wishes so that they can respectfully carry them out.

What if you cannot speak for yourself? Who will speak for you? What are your medical wishes? It is a very heavy burden for loved ones to make medical decisions for you when they do not know what your wishes are, especially during a crisis or an unanticipated illness when you yourself cannot communicate those wishes. By having an advanced healthcare directive it gives your loved ones peace of mind that what they are doing is what you desire and they don’t have to question whether they are doing the right thing for you.

An advanced healthcare directive will allow you to be in control of your wishes, not the doctors or nurses.

Glossary of Terms

These terms are commonly used in Advanced Healthcare Directives.

Artificial nutrition and hydration: Used to replace eating and drinking to sustain the body either through a tube placed in the gastrointestinal tract or a vein. The purpose is to provide nutrition and nourishment to the body in the absence of the ability to eat or drink.

Capacity: Legal status imposed by the court. A person has medical decision making-capacity when he or she is able to understand the medical problem and the risks and benefits to the treatment options.

Cardiopulmonary Resuscitation (CPR): Life saving technique composed of chest compression and artificial ventilation or breathing when a person’s heart or breathing has stopped. Electric shock and various medications are also used to try to restart the heart. Do-Not-Intubate (DNI): A written order by the physician at the request of a person or his or her family to instruct healthcare personnel to not place an endotracheal tube down the patient’s trachea or windpipe to assist with breathing. This order must by signed by a physician for it be valid.

Do-Not-Resuscitate (DNR): A written order by the physician at the request of a person or his or her family to instruct healthcare personnel to not attempt cardiopulmonary resuscitation (CPR) should the person’s heart or breathing stop. This order must by signed by a physician for it be valid.

Durable Power of Attorney for Health Care: Also known as Healthcare Agent or “proxy.” A document that identifies the person whom you have named to make healthcare decision for you when you cannot make those decisions yourself. This should be a person that you trust and have had many conversations about your healthcare wishes.

Hospice: Care for the terminally ill in their last 6 months of life. The goal of hospice is not to cure the patient from their disease, but to provide comfort care to them in their last days.

Incapacity: Often determined by a physician that the person does not have medical decision making-capacity due to the inability to understand the medical problem or the risks and benefits to the treatment options. This is used to activate a Durable Power of Attorney for Health Care.

Intubation: The insertion of an endotracheal tube through the mouth or nose into the trachea or windpipe to maintain a patent airway so the patient can breathe. Most of the time the patient is placed on mechanical ventilation to breath for the patient.

Living Will: A type of Advanced Directive that specifies which medical treatments you do or do not want when faced with a medical crisis, serious illness or end-of-life care, or when you can no longer make those decisions for yourself (e.g., in a coma.). This document may also be called “directive to physicians,” “healthcare declaration,” or “medical directive.”

Mechanical ventilation: Also called a “breathing machine,” a ventilator does the breathing work for the patient by forcing air into the patient’s lungs through an endotracheal tube. This is used when either the person cannot breath on their own or their own breathing is not effective enough to sustain life.

Palliative Care: The goal of care is to provide the patient with the best quality of life for the patient by minimizing suffering and pain. The focus is on the physical, psychological and spiritual needs of the patient. The patient does not have to be in hospice or terminally ill.

Power of Attorney: A legal document giving authority to another individual to act on his or her behalf in private affairs, business, legal and financial matters.

Respiratory arrest: When a person stops breathing. If breathing is not restored, the person’s heart will also stop.

Withdrawing Treatment: Discontinuing life-sustaining treatment(s). Usually occurs when the treatment is no long effective or when the treatment’s harm is greater than its benefit.