Advance care directives allow patients to provide instructions about their preferences regarding the care they would like to receive if they develop an illness or a life-threatening injury and are unable to express their preferences. Advance care directives can also designate someone the patient trusts to make decisions about medical care if the patient becomes unable to make (or communicate) these decisions. This is called designating “power of attorney (for health care).”
Federal law requires hospitals, nursing homes, and other institutions that receive Medicare or Medicaid funds to provide written information regarding advance care directives to all patients upon admission.
Advance care directives can reduce:
- Personal worry
- Feelings of helplessness and guilt by family members
- Futile, costly, specialized interventions that a patient may not want
- Overall health care costs
- Legal concerns for everyone involved
However, advance care directives cannot predict what situations may arise in the future or what new modes of care may be available for situations considered nearly hopeless today.
EXAMPLES OF ADVANCE DIRECTIVES
Verbal instructions. These are any decisions regarding care that are communicated verbally by an individual to health care providers or family members.
Organ donation. This may be accomplished by completing an organ donation card and carrying it in your wallet. A second card may be placed with important papers (such as a living will, insurance papers, and so on). Most hospitals or other major health care centers have organ donor information available.
Many states offer people who are applying for new or renewed driver's license the opportunity to make a decision regarding organ donation and have it recorded on the driver's license. More information may be obtained by calling 1-800-24-DONOR.
Living will. This is a written, legal document that conveys the wishes of a person in the event of serious illness. This document can speak for a patient who is unable to communicate. A living will may indicate specific care or treatment the person does or does not want performed under specific circumstances. This may include specific procedures, care, or treatments such as the following:
CPR(if cardiac or respiratory arrestoccurs)
- Artificial nutrition through
intravenousor tube feedings
- Prolonged maintenance on a respirator (if unable to breathe adequately alone)
Blood cultures, spinal fluid evaluations, and other diagnostic tests
- Blood transfusions
Review Date: 11/17/2010
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.