You know you should have an advance directive. What are you actually supposed to decide before you create one?
It can feel like a lot to figure out. What medical care would you want in a situation you’ve never faced? Who would you trust to make decisions for you if you couldn’t make them yourself? If you feel like you need answers to every question before you begin, it’s easy to put off the whole process.
You don’t need to have every answer before you get started.
Creating an advance directive starts with thinking about what matters to you. From there, you can consider who you trust to speak for you and have conversations with the people who may someday need to understand your wishes. Your estate planning attorney can then help you create the appropriate documents for your circumstances.
Before You Get to the Documents
Before focusing on the legal documents themselves, take some time to think about your priorities.
The National Institute on Aging (NIA) describes advance care planning as preparing for future medical decisions in case you become seriously ill or cannot communicate your wishes. Part of that process involves thinking about your values and the kind of care you would want.
That doesn’t mean you need to make a decision about every medical treatment you might someday encounter.
Instead, start with the bigger questions. What does quality of life mean to you? How important is maintaining your independence? Are there circumstances in which comfort would become more important to you than treatment intended to prolong life?
Personal beliefs, family experiences, and past medical experiences may also shape the way you think about care.
These questions don’t always have quick answers. The purpose is to begin identifying what matters most to you so those priorities can help guide the decisions you make in your advance directive.
You Don’t Have to Predict Every Medical Situation
One reason people may find advance care planning difficult is the sheer number of situations they could imagine.
What if you had a stroke? What if you were seriously injured in an accident? What if you developed dementia? What if doctors expected you to recover, but you temporarily couldn’t communicate?
Trying to plan for every possibility would be overwhelming.
An advance directive gives you a way to provide guidance about future healthcare decisions. Thinking about your broader values can be just as important as considering particular treatments.
For example, someone may feel strongly about remaining able to recognize and communicate with family. Someone else may place a high priority on receiving treatment whenever there is a reasonable possibility of recovery. Another person may have strong feelings about comfort or independence.
Knowing those priorities can help you have more productive conversations with your attorney, healthcare providers, and the person you choose to speak for you.
Consider Talking With Your Doctor
Your healthcare provider can also be a useful part of advance care planning.
NIA recommends talking with a doctor about advance care planning, particularly if you have questions about your health or the medical decisions you could face.
This can be especially helpful if you have an existing medical condition.
A physician can explain what certain treatments involve and what decisions may realistically arise as a condition progresses. That information may help you think about your wishes in more concrete terms.
You can also ask questions about medical language you don’t understand. You aren’t expected to become an expert in medical care before creating an advance directive.
The goal is to have enough information to make choices that reflect your values and priorities.
Think About Who You Trust to Speak for You
Creating an advance directive may also involve deciding who should make healthcare decisions for you if you cannot communicate them yourself.
Depending on the document and state, this person may be called a healthcare proxy, agent, representative, or another similar term.
Choosing someone deserves careful thought.
The person closest to you isn’t automatically the person best suited for the responsibility. Consider whether the person can listen to what you want, ask questions of healthcare professionals, and communicate your wishes during a stressful situation.
Maybe your first instinct is to name your spouse, but your spouse has already told you they don’t know if they could make certain medical decisions for you. Or perhaps there’s someone else in your family who understands your wishes and would be more comfortable speaking with doctors. Those are things worth thinking about before you make your choice.
There is also a more basic question worth asking: Is the person you choose willing to take on the responsibility?
You don’t want the first conversation about the role to happen during a medical emergency.
Make Sure They Understand Your Wishes
A legal document can provide important instructions, but you also need to have the conversation. Your decision-maker needs to understand the thinking behind your choices and what matters most to you.
Explain what matters to you. Talk about your priorities for medical care and any choices you feel particularly strongly about. If there are experiences that influenced your views, you may want to explain those as well.
You don’t need to give your healthcare decision-maker an answer for every situation that could possibly occur. In fact, neither of you can know exactly what a future medical situation will look like.
Helping that person understand your values can give them useful context if they ever have to make a decision you didn’t specifically anticipate.
Work With Your Estate Planning Attorney
Once you’ve started thinking about your wishes and whom you may want to speak for you, your estate planning attorney can help you turn those decisions into the appropriate legal documents.
There is real value in working with an attorney who focuses on estate planning. Your healthcare documents don’t exist in isolation. They may be part of a broader estate plan that also addresses who can act for you in other areas if you can’t make decisions for yourself.
Advance directive laws and terminology vary by state. The documents used to express your treatment preferences may also be different from those used to appoint someone to make healthcare decisions for you.
Your attorney can explain which documents are appropriate for you, what each one does, and what requirements apply where you live.
This is also a good time to ask questions. When would the person you name have authority to act? What types of decisions can the document address? How should particular wishes be expressed?
Are there signing, witnessing, notarization, or other requirements?
You don’t need to walk into your attorney’s office knowing all the answers. Thinking about your priorities beforehand simply gives you a good place to start the conversation.
If you don’t already have an estate planning attorney, don’t let that become another reason to put off the process. Finding an attorney may feel like one more step, but you don’t have to tackle everything at once. Start with the decisions you can make now, and then take the next step when you’re ready.
Make Sure the Document Reflects What You Want
Before completing your advance directive, read it carefully and ask about anything you don’t understand.
Legal and medical terminology can sometimes make a straightforward decision sound more complicated. Don’t assume you should sign something simply because it is a standard part of the planning process.
Your advance directive is supposed to communicate your wishes.
If a provision isn’t clear, ask what it means. If you’re unsure how a choice could apply in an actual medical situation, you may want to discuss it with your physician as well.
The goal isn’t simply to finish another document. It is to create guidance that accurately reflects your decisions if a time comes when you cannot explain them yourself.
Share Your Advance Directive With the Right People
Once your advance directive is complete, don’t let the conversation end there.
NIA recommends giving copies of advance directives to the appropriate people, which may include your healthcare proxy, healthcare providers, loved ones, and attorney.
Your healthcare decision-maker should know that the completed document exists. The people closest to you should also understand whom you have chosen to make decisions if you cannot make them yourself.
Sharing that information ahead of time can reduce uncertainty later.
It also gives you another opportunity to talk about your wishes. Family members don’t necessarily need to agree with every decision you make, but knowing your wishes in advance may help them understand the choices you have made.
So, Where Do You Start?
You don’t need a detailed answer for every possible medical situation before you begin creating an advance directive.
Start with what you know about yourself.
Think about what matters to you. Consider whom you would trust to speak for you. Talk with that person about your priorities. Ask your healthcare provider questions about medical issues you don’t understand. Then work with your estate planning attorney to create the appropriate documents.
An advance directive is designed for a time when you may not be able to explain your healthcare wishes yourself. The process of creating one gives you the opportunity to think about those wishes now — and make sure the people who may someday need to act on them understand what matters to you.
National Insitute on Aging, “Advance Care Planning: Advance Directives for Health Care,” Read the full article here.