What is advance directives

Documents providing written instructions regarding treatment decisions should a person become incapacitated and unable to express such desires when care is needed. Advance directives are particularly important with regard to end-of-life care for people with progressive conditions such as Parkinson’s disease. Each state has procedures and processes for creating and implementing advance directives. In most states, two documents comprise advance directives, a living will and a durable power of attorney for health care (DPHC). Local Parkinson’s disease support groups, senior centers and programs, hospitals, medical clinics, physician offices, and extended care facilities such as assisted living centers, skilled nursing facilities, and long-term care centers typically have information about advance directives specific to relevant laws, regulations, and procedures to follow to make certain advance directives are valid and followed if needed.

It is important for family members or close friends to know about advance directives and the desires these documents specify. The person who is most responsible for assisting with care, or who would be most likely to make health care decisions on the incapacitated person’s behalf, should receive copies of advance directive documents. Copies also should go to the physician responsible for care for inclusion in the medical record. The earlier in the course of a progressive condition such as Parkinson’s disease that advance directives are prepared, the better. A person may always modify or withdraw advance directives.

Living Will

A living will stipulates a person’s preferences for medical treatment at the end of life, including whether to initiate or continue cardiopulmonary resuscitation (CPR), lifesaving measures such as mechanical ventilation, and other considerations. The easiest way to prepare a living will is to fill out and sign standardized forms available through many health care providers, bookstores, and stationery stores. It is important to use forms of documents that follow relevant state laws and procedures. Some states require the signatures of witnesses to make a living will valid, while others require only the signature of the person completing the living will. The person who signs a living will can change or revoke it at any time, even during a medical crisis when death seems imminent if the person is capable of communicating his or her wishes.

Durable Power of Attorney for Health Care (DPHC)

Durable power of attorney for health care (DPHC), called health care proxy in some states, is a legal document that gives one person the right to make medical treatment decisions on behalf of another person. This can be a trusted family member or friend. In most states, it cannot be a doctor, nurse, or other health care professional unless there is a relationship by blood, adoption, or marriage.

Because DPHC is a legal document, it is more formal than a living will and requires the signatures of two witnesses (in most states). Typically the person to whom the DPHC is assigned (sometimes called the health care agent) cannot be one of the witnesses, although health care professionals and employees can. It is a good idea to designate a primary and an alternate health care agent; some DPHC forms require this. A DPHC can be changed simply by replacing it with a revised document. Make sure all copies, including those provided for inclusion with health care records at the doctor’s office and at the hospital, are replaced.

A DPHC assignee, or health care agent, is authorized to make decisions regarding the person’s medical treatment including end of life decisions. It is important that this assignee understand the person’s desires and be willing to make sure they are honored. These desires might include those expressed in a living will as well as other preferences related to matters such as surgery and emergency medical care. A DPHC covers any circumstance in which the person becomes unable to make his or her own health care decisions, not only the end of life. Because it is not possible to anticipate when or how such an inability might occur, it is a good idea to have a DPHC prepared.

See also end of life care; estate planning;

FINANCIAL PLANNING; HOSPITALIZATION; HOSPICE; MEDicaid; medical management; palliative care; planning FOR THE FUTURE.