Advance healthcare directives — sometimes called living wills — are powerful legal tools that allow you to document your medical wishes before a crisis. But here’s the surprising truth: research shows that even when patients have completed directives, they’re often not available in the emergency department (ED) when needed most.
A 2024 study in BMC Health Services Research reviewed advance directive use in emergency care, highlighting a critical gap: availability. At Legal Directives, we believe it’s not just about having these documents — it’s about ensuring they can guide your care when seconds count.
What Is an Advance Healthcare Directive?
An advance healthcare directive is a legal document that states:
- What medical treatments you want or don’t want.
- Who should make decisions for you if you can’t speak for yourself.
- Your preferences for end-of-life care.
These documents give peace of mind to families, protect your autonomy, and help doctors make the right choices in emergencies.
Key Findings From the Research
The systematic review found:
- Only 20–28% of adult patients report having an advance directive.
- Among older or medically fragile patients, the percentage varies widely (2.6%–79%).
- In actual emergencies, fewer than 7% of directives are available to ER staff.
This means the majority of patients’ wishes go unheard in the moments when they matter most.
Why Availability Is More Important Than Completion
Having a living will in your desk drawer won’t help you in the emergency room. If doctors can’t access your advance directive:
- Your wishes may be ignored — resulting in treatment you don’t want.
- Families may face conflict — making decisions under stress without guidance.
- Care defaults to aggressive treatment — which may not reflect your values.
Barriers to Advance Directive Use in Emergencies
The study uncovered several reasons directives fail in the ER:
- Paper copies are left at home or stored in inaccessible places.
- No system exists to share documents between nursing homes, hospitals, and emergency teams.
- Lack of standardized, digital access across healthcare settings.
How to Ensure Your Advance Directive Is Available 24/7
Here are best practices to protect your healthcare choices:
- Complete an advance directive now — don’t wait until it’s too late.
- Use a secure digital service (like Legal Directives) that makes your documents available anytime, anywhere.
- Inform your family and healthcare providers where your documents are stored.
- Review and update regularly to keep your wishes current.