What Is an Advance Directive? Definition + Purpose


Certified Care Manager, Aging Life Care Professional, and National Master Guardian Emeritus

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Many people can be confused by the definition and purpose of an advance directive, as there are many different names for forms that can fulfill similar objectives. Other complicating factors include not knowing how to set up advance directives, when to do it, and who to grant authority to for health care and financial decisions. Not every situation is the same, as your health condition may change over time and so may your relationships. 

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While these obstacles may seem large and unwieldy, it is worth filling out advance directives to avoid the chaos and stress that occurs when there is no advance directive in place. Many times, something sudden can happen where the family needs to make decisions on your behalf. We will walk you through not only setting up advance directives but also the reasons advance directives are crucial to making sure that your wishes are honored. 

Definition of Advance Directive

Simply put, advance directives state the medical care you would want if you were too ill or hurt to express your wishes. Advance directives are legal documents (sometimes one or several documents) that allow you to spell out your end-of-life and health care decisions ahead of time. 

Advance directives also give you the opportunity to be very specific about the medical interventions you want if you can’t speak for yourself. The first thing you may be thinking is “that all depends.” Most advance directives allow you to state under what conditions you want life-sustaining treatment.

If you think about it, if you had a family member that became ill or unconscious due to an unexpected injury, you would appreciate a roadmap to help guide you when making decisions on their behalf.  

Advance directives also provide a named agent with the authority to manage your finances if you cannot. You may prefer one person to manage your health care and another to make decisions about your finances, and that is acceptable. The point of advance directives is that you get to decide what is best for you.

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What Are the Other Names for Advance Directives?

The other terms for advance directives are where things get really confusing. If only there were a uniform name for these documents in every state, but that is not the case. Each state dictates what to call an advance directive and the forms that you should use. As a result, you will want to make sure that you are using the documents that the state and court recognize in your state. 

Here are just a few of the other names for advance directives, and some of these terms require a separate document:

  • Advance health care directive
  • Living will
  • Durable power of attorney for health care
  • Declaration as to medical or surgical treatment
  • Document concerning health care and withholding or withdrawal of life support systems
  • Declaration
  • Durable power of attorney for health care decisions
  • Advance directive
  • Document directing health care
  • Proxy directive
  • Living will declaration
  • Declaration to physicians
  • Power of attorney for health care

What’s the Purpose of Advance Directives?

The purpose of advance directives starts with you. The process of deciding what is essential to you should you be unable to speak for yourself can bring up some distressing emotions. But the alternative is worse—you don’t want someone else making decisions that may not be consistent with your values, wishes, and ethics. 

Most of us find it challenging to try and think about possible scenarios that involve delicate and personal decisions. If you are younger, your advance directives could look very different from those of someone who is in their 90s.

You can’t anticipate every possibility, so take some time to discuss your wishes with your health care providers and those closest to you if your directive doesn’t provide a clear mandate for a particular situation.

Give some thought to and under what conditions you would like a trial of life-extending interventions, such as the following:

  • Resuscitation. This decision can depend on your age, your medical condition, and under what circumstances it may be necessary. Cardiopulmonary resuscitation (CPR) may not restore you to your previous level of functioning. Some people can sustain brain damage, and in other cases, a person may prefer for a terminal disease to follow its natural course.
  • Mechanical ventilation. Without this intervention, you can’t breathe independently.
  • Tube feeding In some cases, tube feeding is necessary beyond a medical crisis, to keep you alive.
  • Dialysis
  • Pain control
  • Organ and tissue donation
  • Body donation for science.

Why Are Advance Directives Important?

There are four main reasons that advance directives are important:

First, advance directives allow you to express your wishes and give you choice about what treatments or procedures are used. Secondly, advance directives can reduce the possibility of family conflict. In some cases, family conflict can also lead to legal conflict.

Third, having this already setup can minimize stress for family members and health care providers when the time arrives to make decisions. Finally, it gives your loved ones peace of mind knowing that you have documents in place to guide them.

In the absence of a living will, care decisions become the responsibility of a partner, spouse, and family members with input from medical professionals. If you have given verbal instruction, there is no legal obligation for the family to follow them. 

What Are the Three Types of Advance Directives?

Now that you know how many names there are for advance directives, we can group them into three broad types.

1. Living will

A living will is not to be confused with a last will and testament, in which property and personal items are distributed after death. A living will is a document where you specify the types of medical treatment you want if you become incapacitated. A living will can be general or very specific and cover treatment such as antibiotics, artificial hydration, pain medications, feeding tube, breathing machine, dialysis,  and do not resuscitate (DNR) orders.

A living will does not mean that you don’t necessarily want to receive comfort care, and you can specify that. You also have the right to change your living will at any time you choose.  A living will is also called a medical directive or health care proxy. 

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2. Durable power of attorney for health care or health care proxy

A health care proxy is someone you name to make decisions on your behalf should you become unable to speak for yourself. You fill out a form to designate the authority and responsibility of a health care proxy. Make sure to think about this carefully, as you will have to trust this person to decide your treatment and medical care if you are unable to do so. 

3. Durable power of attorney for finances

If you cannot speak for yourself, you need not only someone with the authority to make health care decisions but also financial decisions. A few of the responsibilities of a financial power of attorney include:

  • Accessing bank accounts, paying bills, and handling investments
  • Buying and selling property
  • Filing tax returns
  • Settling debts
  • Applying for or managing government benefits

The other form that might come up is the POLST form (Physician’s Order for Life Sustaining Treatment). Although it is not considered an advance directive the POLST plays a very important role in specific circumstances. A POLST form requires a physician’s signature and is used if you are facing a life threatening medical situation. 

Do You Need an Advance Directive?

If you are over the age of 18, you need an advance directive, as parents have legal guardianship of anyone under the age of 18. The fact is that accidents happen at any age and without an advance directive, a young person has no one (not even their parents) to make decisions about their care and treatment. 

In addition, obtaining medical information about someone’s condition is prohibited by law unless someone has the legal authority to do so. Although a young person may not be clear about what procedures they want or don’t want during an emergency, they can designate a trusted person to make those decisions for them.

Steps for Creating an Advance Directive

The steps for creating an advance directive may differ depending on where you live, but in general, there is a process to follow. If you feel more comfortable using an attorney, they can walk you through and ensure that all documents meet state requirements. 

Step 1: Find advance directives for your state

The first step in establishing advance directives is to find the correct advance directives for your state. If you have residences in more than one state, you will want to have an advance directive for each state. Reviewing the advance directives for your state gives you a starting point for thinking about your wishes. Think of the document as a guide.

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Step 2: Discuss with family and others

Now comes the hard part. You may have clear ideas about the type of care you want and who you wish to designate as your proxy. However, if you don’t, talk with friends and even spiritual advisors about the process.

Once you settle on who you want as your power of attorney for health care and finances, speak with that person about the responsibility of that role and whether they are prepared to accept it. Choose your health care and financial proxy carefully. You want someone you trust. 

Step 3: Fill out the forms and distribute

Next, fill out the forms. If a notary and or witnesses are required, make sure you comply with the law in your state. Advance directives won’t do much good if your family and health care providers don’t have copies. Distribute copies to your health care team and family.

An easy way to give trusted people access to the document when needed is to use Cake’s planning process to upload documents and share them with whomever you decide. Always keep hard copies in your loved one’s home in case of emergency, and you need immediate access to the documents.

Step 4: Review advance directives regularly

Review all advance directives annually or more often if needed. Things can and do change— that goes for both your health care and your relationships. Your thinking may shift in time about your end-of-life or treatment options, and you must document those.

Also, the relationship with the person you selected as your health care proxy may change, and you may feel more comfortable with someone else. Divorce, death, changes in health status are all reasons to revisit your advance directives as soon as possible. 

You have the right to change your advance directives at any time you choose. Don’t forget to go through the distribution process again since past advance directives no longer have legal standing. 

Advance Directives and Their Definition and Purpose

Planning for the future can be a challenge, but advance directives should take priority. Yes, there is work involved and some soul searching. That said, the benefits to you and your family are undeniable. Get started as soon as you can and once your advance directives are complete, you can have peace of mind. 

infographic of steps for creating an advance directive

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