of Having an Advance Health Care Directive
By Shahed Hasan
The Terry Schiavo
case has raised a variety of legal and moral issues
about when a person can be allowed to die. But an
advance health care directive spelling out her wishes
could have prevented the family’s battle over
her care. While the Schiavo case has received widespread
attention, thousands of other families face the
same life or death decision every day.
What is an “Advance
Health Care Directive”?
An “advance health care directive” or
“advance directive” is a document in
which you give instructions about your health care
if, in the future, you cannot speak for yourself.
You can give someone you name (your “agent”)
the power to make health care decisions for you.
You can also give instructions about the kind of
health care you do or do not want.
Why is it useful?
In a traditional “living will,” you
state your wishes about life-sustaining medical
treatments if you are terminally ill. Unlike most
living wills, an advance directive is not limited
to cases of terminal illness. If you cannot make
or communicate decisions because of a temporary
or permanent illness or injury, an advance directive
helps you keep control over health care decisions
that are important to you. In your advance directive,
you state your wishes about any aspect of your health
care, including decisions about life-sustaining
treatment, and choose a person to make and communicate
these decisions for you.
It is particularly important to appoint an agent.
When a decision needs to be made, your agent can
participate in discussions and weigh the pros and
cons of treatment based on your wishes. Your agent
can decide for you whenever you cannot decide for
yourself, even if your decision-making ability is
temporarily limited. If you do not formally appoint
someone to decide for you, many health care providers
and institutions will make critical decisions that
might not be based on your wishes. In some situations,
a court may have to appoint a guardian unless you
have an advance directive. An advance directive
can also relieve family stress. By expressing your
wishes in advance, you help your family or friends
who might otherwise struggle to decide on their
own what you would want to be done.
What does an Advance
An advance directive normally contains two parts.
The first part is the appointment of an agent for
you if you cannot decide for yourself. You can define
how much or how little authority you want your agent
to have. You can also name persons to act as alternate
agents if your primary agent is unavailable, and
disqualify specific persons whom you do not want
to make decisions for you. If there is no one whom
you trust fully to serve as your agent, then you
should not name an agent. Instead, you can rely
on the second part of the advance directive to make
your wishes known.
The second part of the advance directive contains
specific instructions about your health care treatment.
If you choose, you can also include a statement
about donating your organs. Your instructions in
the second part provide evidence of your wishes
that your agent, or anyone providing you with medical
care, should follow.
You can cancel or change your advance directive
by telling your agent or health care provider in
writing of your decision to do so. Destroying all
copies of the old one and creating a new one is
the best way. Be sure to give a copy of the new
one to your physician and anyone else who received
the old one.
What happens if you
do not have an Advance Directive?
If you do not have an advance directive and you
cannot make health care decision, some state laws
give decision-making power to default decision-makers
or “surrogates.” These surrogates, who
are usually family members in order of kinship,
can make some or all health care decisions. Some
states authorize a “close friend” to
make decisions, but usually only when family members
Even without such laws, most doctors and health
facilities routinely consider family, as long as
there are close family members available and there
is no disagreement. However, problems can arise
because family members may not know what the patient
would want in a given situation. They also may disagree
on the best course of action. Disagreement can also
undermine family consent. A hospital physician or
specialist who does not know you well may become
your decision-maker, or a court proceeding may be
necessary to resolve a disagreement.
In these situations, decisions about your health
care may not reflect your wishes or may be made
by persons you would not choose. Family members
and persons close to you may go through needless
agony in making life and death decisions without
your guidance. It is far better to make your wishes
known and appoint an agent ahead of time through
an Advance Directive.
The importance of
Too few of us do advanced planning. It’s important
for all adults, not just for old people. Indeed,
the young in many ways have more at stake because
serious medical decisions can have consequences
that last decades. Don’t fall into thinking
that planning for the worst makes the worst happen.
That’s not true. Planning now for future health
care decisions is a priceless gift to your loved
ones and to yourself. There is no choice in the
matter when it comes to death, but there is a choice
about how you can die, and that can be a good thing.