Essential Advance Directive Information

What Is An Advance Directive?

An advance directive is an essential health and estate planning document that helps to ensure that your health care wishes will be respected in the event that you become unable to voice them yourself. While these wishes can be committed orally, it is important to have these expressed in writing, in order to protect your family, and yourself, if you become seriously injured or develop an illness that may prevent you from actively participating in decisions regarding your medical care.

Are There Different Types Of Advance Directives?

There are actually two main types of advance directives: a living will, also known as a treatment directive, and medical power of attorney.

A living will, or treatment directive, is a way to document personal wishes regarding end of life medical treatment in the event that your decision making and communication abilities are lost.

A medical power of attorney is a legal document that allows you to appoint someone to be your health care agent or health care proxy to make medical treatment decisions for you at any time that you are unable to make such decisions yourself.

How Should I Prepare My Advance Directive?

There are four steps to preparing a proper advance directive, and they are as follows: obtaining appropriate living will and/or medical power of attorney forms applicable to your state of residence, choosing someone who will act as your health care agent, completing the forms and having them notarized or witnessed as your state requires, distributing copies to your doctor, family, and health care agent.

Since forms do vary by state, it is important to obtain the correct ones. These can be found at your doctor’s office, or at a local hospital, law office, senior center, nursing home, or any state or local office designated to serve elderly persons.

Which Issues Should I Consider When Preparing An Advance Directive?

There are many issues to consider, as well as key questions to ask yourself when you are preparing an advanced directive. Some of these key questions include: Should I receive artificial hydration and nutrition? Should I receive CPR and mechanical ventilation? Should I stop kidney dialysis treatment? Should I receive life prolonging treatment?

Should I receive artificial hydration and nutrition?

If you have been diagnosed with a potentially life limiting illness, you should discuss treatment options, as well as the possibility that artificial hydration, artificial nutrition, or a combination of the two will increase your survival and quality of life. You should also discuss with your doctor the benefits and risks of both electing to receive, and not receive this treatment. Your decision will ultimately depend on both the information that you receive, and your personal beliefs regarding this issue.

There are several factors that will be involved in your decision to receive artificial hydration and/or nutrition, which include: your medical condition. The short term use of IVs, hypodermoclysis (this is the injection of fluids directly into tissues beneath the skin) and artificial feeding tubes are beneficial to many people who are seriously ill, but these treatments may also prolong life while reducing its quality for some. It depends again, on the type of illness you have and the severity of its symptoms.

Another issue to consider is your comfort. People react to artificial nutrition and hydration in different ways, meaning that while some people feel better when receiving this treatment, the fluids received through IVs and feeding tubes can pose problems for some. These problems can include swelling in the arms and legs, as well as fluid in the lungs, and stomach bloating.

Your personal beliefs should also be taken into consideration when it comes to the decision of whether to receive artificial nutrition and hydration. You may feel that using IV fluids, hpodermoclysis, or artificial feeding tubes artificially and unnaturally prolongs life. On the other hand, you may believe that food and water are basic human needs that should always be provided to individuals regardless of the method or circumstances.

Should I receive CPR and medical ventilation?

The decision to receive CPR and mechanical ventilation in the event that you are diagnosed with a potentially life limiting illness or condition will depend on several factors. The first ones will involve your medical problems and overall health, since recent studies have shown that people who have more than one medical problem are less likely to benefit from CPR than individuals with one medical problem.

Another thing to consider, as always, is your personal beliefs. You may feel very strongly that CPR and mechanical ventilation artificially prolongs the natural dying process, or you may be of the opinion that in spite of certain limitations, your life will still have quality.

You should also think about your life goals, since a potentially life limiting illness will more than likely force you to adjust these goals. If you feel that you lived a rewarding life to date, you may be less likely to opt for life support methods. If, however, you feel that prolonging your life and resuming your activities are necessary actions for medical personnel to take, you should be sure to include your wishes expressly within your advance directive.

Should I Stop Kidney Dialysis Treatment?

When you have been diagnosed with kidney failure and are undergoing dialysis, the two most important factors that will effect your treatment choices are your general quality of life and your chance for kidney transplantation. If transplantation is not an option, and if you have been informed that regular dialysis treatments are required to sustain your life, you should consider the following things before electing to stop your dialysis treatments:

Your physical health while on dialysis.

You may feel physically better on dialysis than you did before the treatment, but if you are prone to the side effects of dialysis, or develop complications, you may decide that ongoing dialysis is simply too difficult.

If your dialysis treatments allow you to return to the activities that you have always participated in, you may feel that dialysis does not significantly change your lifestyle. If this is not the case, however, you may decide that the quality of your life while on dialysis is not adequate.

You should also consider you life goals, since the diagnosis of kidney failure will force you to adjust them. You may feel that your life has been long and full and that continuing dialysis would merely prolong pain, or you may be of the opinion that you have many more things to accomplish in your life, and that continuing dialysis is the only way to ensure that you are able to do so.

Should I Stop Life Prolonging Treatment?

The decision to discontinue life prolonging treatment will include several factors. The first one is the type of illness that you have, since with some serious illnesses, curative treatments may be available. These diseases include skin cancer, cervical cancer, and testicular cancer. Other serious illnesses, however, such as diabetes and AIDS, can be managed rather than cured. Some illnesses are also more aggressive and life limiting than others.

Another thing to consider is your treatment options. Some treatments options may give you the chance to cure a disease with little impact on your quality of life, while other treatments may prolong your life but also be associated with side effects that will significantly lower the quality of your life.

Your age and other health conditions should also be considered, as older people with multiple conditions are less likely to recover quickly and respond to treatment than healthier, younger individuals.

Once My Advance Directive Has Been Written, Can I Change My Mind?

You can modify, change, or revoke your advance directive at any time simply by completing new forms, destroying existing forms, and by telling your caregivers. Just be sure that you remember to tell everyone involved.