What Types of Decisions Can You Include in Your Advance Directive?
Feb. 6, 2025
One of the key aspects of estate planning is the advance directive. This documents how you want to be treated when you might not be able to express your preferences due to illness or injury.
At my firm, David W. Walker Attorney at Law in Columbia, Missouri, estate planning isn’t just about organizing assets—it’s about making sure your wishes are honored.
Knowing what types of decisions can be included in your advance directive can help you make sure your desires are fully understood. Here are some of the key choices you can include in your advance directive to make sure your medical and personal wishes are respected.
Types of Decisions in an Advance Directive
An advance directive typically involves two primary types of documents: a living will and a durable power of attorney for health care. The living will outlines your preferences for medical treatments, while the durable power of attorney designates someone to make health care decisions on your behalf if you’re unable to do so.
Within both types of documents, there are several specific decisions you can make regarding your treatment preferences.
Medical Treatment Preferences
One of the most important aspects of an advance directive is specifying how you want to be treated in different medical situations. These decisions can range from end-of-life care to everyday medical treatments. It's essential to communicate your wishes clearly so your medical providers and loved ones understand what you would want.
Life-Sustaining Treatments
These treatments are used to extend your life, even if there’s no realistic hope for recovery. You can decide whether you want to receive treatments like:
Mechanical ventilation: A machine that helps you breathe if your lungs fail.
Cardiopulmonary resuscitation (CPR): A technique used to restart the heart if it stops.
Dialysis: A procedure that filters toxins from the blood when the kidneys no longer function.
End-of-life Care
An advance directive allows you to make decisions about end-of-life treatments, ensuring that your wishes are honored if you are terminally ill or in a coma. You might want to specify:
Do not resuscitate (DNR): A request not to perform CPR if your heart stops.
Do not intubate (DNI): A request not to have a breathing tube inserted if you stop breathing.
Palliative care: Treatment focused on providing relief from the symptoms and pain of a serious illness rather than trying to cure the illness.
Organ and Tissue Donation
You can indicate your preferences regarding organ and tissue donation in your advance directive. You may choose to donate all your organs, specify certain organs for donation, or decline organ donation altogether.
Medical Procedures and Treatments
You can also express your preferences for more routine medical treatments. This might include decisions about:
Antibiotics: Whether or not you want antibiotics to treat infections, especially if they could prolong your life without improving your condition.
Pain management: Whether you want to receive pain medication to ease discomfort, even if it might hasten the end of life.
Blood transfusions: Whether you would accept or decline blood transfusions in a medical emergency.
Mental Health and Psychosocial Care
In some cases, your advance directive might also include decisions about your mental health care. This is particularly important if you suffer from a mental illness or want to clarify how you would like to be treated if you were unable to communicate your wishes during a mental health crisis.
Psychiatric Treatment
You can specify whether or not you want psychiatric treatments such as medication or hospitalization if you are unable to make decisions for yourself due to mental illness. This can help your healthcare providers avoid treatments that you would not want and make sure you receive care that aligns with your beliefs.
Psychosocial Support
In addition to medical treatments, you may want to specify how you would like to receive emotional and social support during difficult times. This might involve specifying preferences for visitation, communication with loved ones, or spiritual care.
Selection of Health Care Proxy
One of the key features of an advance directive is the appointment of a health care proxy or agent. This is a person you trust to make medical decisions on your behalf if you are unable to do so. The person you select can help make sure that your medical care aligns with your wishes, particularly in ambiguous situations.
Your health care proxy should be someone who knows you well, understands your values, and is comfortable making difficult medical decisions on your behalf. This person does not need to be a medical professional but should have the ability to advocate for your preferences effectively.
Powers of the Health Care Proxy
You can grant your health care proxy the authority to make specific types of medical decisions on your behalf. These decisions might include:
Consent to medical treatments: Whether or not your proxy can approve treatments that align with your wishes.
End-of-life decisions: Whether your proxy can make decisions related to life support or the withdrawal of treatments if you are terminally ill or in a vegetative state.
Transfer to a different facility: Whether your proxy can decide if you should be moved to another hospital, hospice, or care facility.
If You Have Multiple Proxies
You might want to name an alternate proxy in case your first choice is unavailable or unable to carry out the role. This assures that someone is always available to make decisions on your behalf when necessary.
Legal and Religious Considerations
Your advance directive should also take into account any legal or religious considerations that may impact your medical treatment. These considerations might include religious beliefs about certain treatments or preferences regarding how you would like your estate handled in the event of your incapacity.
Religious Beliefs
Some individuals may have religious objections to certain types of medical treatments, such as blood transfusions or certain life-sustaining measures. Your advance directive should clearly state your preferences based on these beliefs.
Legal Considerations
Depending on where you live, different states or regions may have specific laws governing advance directives and medical treatment decisions. Consulting with a lawyer ensures that your advance directive is legally valid and that your wishes will be honored in accordance with the law.
Living Will vs. Durable Power of Attorney for Health Care
When creating your advance directive, it's important to understand the difference between a living will and a durable power of attorney for health care. These two components work together but serve distinct purposes.
Living Will
A living will provides specific instructions about the kind of medical treatment you would want or not want if you’re unable to communicate. This document typically includes instructions about end-of-life care, organ donation, and life-sustaining measures.
Durable Power of Attorney for Health Care
A durable power of attorney designates someone to make medical decisions on your behalf. While a living will sets out your treatment preferences, the durable power of attorney gives someone the authority to make decisions in situations where your preferences may not be clear.
While both documents are important, the durable power of attorney is crucial in situations where your wishes are not clear or where medical professionals need to make decisions quickly.
Regularly Review Your Advance Directive
Creating an advance directive is not a one-time event. As your health or circumstances change, it’s essential to review your advance directive to make sure it still reflects your current wishes. This may be especially important if you experience a significant change in health, develop new medical conditions, or if laws governing medical care change.
Updating Your Advance Directive
You should review and update your advance directive every few years or after major life changes, such as a new marriage or the birth of a child. It’s also important to update your advance directive if you want to change your designated proxy or make any adjustments to your medical preferences.
Communicate Your Wishes
It’s not enough to simply have an advance directive—make sure your family members, healthcare providers, and the person you’ve chosen as your health care proxy are aware of your wishes. Having open conversations about your preferences can help avoid confusion and make sure that your decisions are respected when the time comes.
Call Today to Learn More
If you’re ready to create or review your advance directive, I’m here to help. My firm in Columbia, Missouri serves clients throughout Jefferson City, Fulton, Boonville. Reach out to David W. Walker Attorney at Law today to get started.