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Advance Directives
“Advance Directives” is a term that refers to your right to make decisions about medical treatment.
Your doctors will give you information and advice about treatment, but the ultimate decision is yours. You can say, “yes” to treatments you want. You can say “no” to any treatment that you don’t want, even if the treatment might keep you alive longer.
Advice from your doctor
Your doctor must tell you about your medical condition and about what different treatments and pain management alternatives can do for you. Your doctor must also inform you about any side effects that medical treatment is likely to cause you.
Often, more than one treatment might help you, and different people may have different ideas about which is best. Your doctor can tell you, but your doctor can’t choose for you. That choice is yours to make, and it depends on what is important to you.
Advice from family and friends
You can ask family and close friends for help in making medical decisions. They can help you think about the choices you face. You can ask the doctors and nurses to talk with your relatives and friends. They can ask the doctors and nurses questions for you.
Having someone else make the decision
If you wish, you may tell your doctor that you want someone else to make health care decisions for you. Ask the doctor to list that person as your health care “surrogate” in your medical record. The surrogate’s control over your medical decisions is effective only during treatment for your current illness or injury.
If you’re too sick to decide
If you’re too ill to make a decision about your medical treatment, and you have not named a surrogate, your doctor will ask your closest available relative or friend to help decide what is best for you. Most of the time that works. However, sometimes everyone does not agree about what to do. This is why it’s important for you to tell us in advance what you want if you are unable to speak for yourself later.
Be prepared with an Advance Health Care Directive
It’s better to make medical decisions before you get very sick or have to go into a hospital, nursing home, or other health care facility. Simply fill out an “Advance Health Care Directive” document, in which you’ll indicate an adult family member or friend as your health care “agent” (see below) to speak for you and what kind of treatments you want. You can complete this document yourself (you don’t need a lawyer) if you are 18 or older and are capable of making your own medical decisions.
This document is called “Advance” because you prepare one before health care decisions need to be made. It’s called “Directive” because the document states who will speak on your behalf and what should be done.
The Advance Health Care Directive may include two parts: a “Power of Attorney for Health Care,” and an “Individual Health Care Instruction.” They may be used together or separately.
- In California, the part of an Advance Health Care Directive document that you can use to appoint an agent to make health care decisions for you is called a “Power of Attorney for Health Care.” Your agent can make most medical decisions, not just those about life-sustaining treatment, when you can’t speak for yourself. You can also let your agent make decisions earlier, if you wish.
- The part where you can express what you want done is called an “Individual Health Care Instruction,” which you create by writing down your wishes about health care or by talking with your doctor and asking him/her to record your wishes in your medical file. If you know when you would or would not want certain types of treatment, the Individual Health Care Instruction provides a good way to make your wishes clear to your doctor and anyone else who may be involved in deciding about treatment on your behalf.
Of course, even if you do not complete an “Advance Health Care Directive” document, you will still receive medical treatment. We just want you to know that if you become too sick to make decisions, someone else will have to make them for you.
You can change or cancel your Advance Health Care Directive instructions at any time, as long as you can communicate your wishes to the doctor in charge of your care.
About your health care agent
Usually, a health care agent will make decisions only after you lose the ability to make them yourself. If you wish, though, you can state in the Power of Attorney for Health Care that you want the agent to begin making decisions immediately.
After you choose your agent, talk to that person immediately about what you want. Sometimes treatment decisions are hard to make, and it truly helps if your agent knows your wishes. You can also write your wishes down in your Advance Health Care Directive document.
When someone else decides your treatment
When you indicate that you want your health care decisions made by your health care agent, your surrogate, or a person appointed by a court to make decisions for you, the same rules apply as if you’re making those decisions yourself. They are required to follow your Health Care Instructions and/or your general wishes about treatment, including stopping treatment. If you haven’t indicated your treatment wishes, your surrogate must try to determine what is in your best interest.
The people providing your health care must follow the decision of your agent or surrogate unless a requested treatment would be bad medical practice or ineffective in helping you.
If you don’t want to name an agent…
You can still write out your wishes in your Advance Health Care Directive document, without naming an agent. You can say, for example, that you want to have your life continued as long as possible, or you can say that you would not want treatment to continue your life. Also, you can express your wishes about the use of pain relief medications or any other type of medical treatment.
Even if you have not filled out a written Individual Health Care Instruction, you can discuss your wishes with your doctor, and ask your doctor to list them in your medical record. You can discuss your wishes with your family members or friends.