Advance directives may seem like something to consider later in life. An unexpected illness or injury, however, can affect your ability to communicate your healthcare wishes at any age.
The National Council on Aging (NCOA) makes this point in its guidance on advance directives. Planning ahead gives you the opportunity to make your voice part of future healthcare decisions before a situation arises when you may be unable to communicate your wishes.
That makes advance care planning relevant long before a medical crisis occurs.
NCOA’s guidance offers several practical lessons about when to plan, what to consider, and why the process involves more than completing a form.
Advance Directives Are Not Just for Older Adults
Despite its focus on aging, the guidance makes clear that advance directives are not only for older adults.
Anyone can experience an unexpected medical situation that affects the ability to communicate or make decisions. NCOA gives examples that include head trauma, stroke, coma, dementia, terminal illness, and other forms of incapacity.
An advance directive provides a way to document healthcare preferences before one of those situations occurs.
Thinking about these decisions earlier also gives you time. Instead of confronting unfamiliar questions during a health crisis, you can learn about your options and consider what matters to you.
Your preferences may change over time. Planning early does not mean making one set of decisions that must remain unchanged for the rest of your life. It means beginning the process while you have the opportunity to participate fully in it.
You Remain in Control of Your Healthcare Decisions
Some people may hesitate to complete an advance directive because they worry about giving up control over their healthcare.
According to NCOA, as long as you can state your wishes, you continue to make your own healthcare decisions. Advance directives provide guidance for circumstances when you cannot communicate those choices yourself.
That distinction is important.
Writing down your preferences does not mean that someone else immediately begins making medical decisions for you. Instead, you are documenting information that may be needed if circumstances change.
In that sense, advance care planning can help you communicate your wishes beyond a time when you may be able to express them yourself.
Advance Directives Can Include More Than One Document
“Advance directive” is an umbrella term rather than the name of one specific document.
NCOA discusses two commonly used documents: a living will and a medical power of attorney.
A living will provides written guidance about certain medical treatments you would or would not want. A medical power of attorney allows you to designate someone to make healthcare decisions on your behalf when that authority applies.
These documents serve different functions, but they can work together.
Written instructions can provide important guidance about your preferences. A person authorized to make healthcare decisions can respond to circumstances that may not be specifically addressed in those instructions.
The exact terminology, requirements, and available documents vary by state. Understanding what each document is designed to accomplish can help you determine what belongs in your own advance care plan.
Learn About Your Treatment Choices
A living will can include preferences about medical interventions that may be considered during a serious illness or at the end of life.
The guidance discusses several examples, including CPR, antibiotics, feeding tubes, dialysis, defibrillators, and ventilators. It also encourages people to talk with their healthcare team as they consider these decisions.
These can be difficult choices to make without understanding what the treatments actually involve.
A healthcare provider can explain what a particular treatment does and when it may be recommended. You can also ask about factors that could affect the possible outcome.
The answer may not always be a simple yes or no.
Someone’s feelings about a treatment could depend on their overall health, likelihood of recovery, or the circumstances in which the treatment would be used. Learning more about those possibilities can help you make choices that better reflect your priorities.
You do not need to become an expert in medical care. Asking questions can simply help you understand what you are being asked to decide.
Creating an Advance Directive Is a Process
NCOA describes creating an advance directive as a process, not simply a matter of completing a document.
You may need time to think about your values and what quality of life means to you. It may also help to discuss your thoughts with your healthcare provider or the people closest to you. Some questions may be easy to answer, while others may require more thought.
There is no need to feel pressured to make major decisions overnight.
That is an important reminder. Advance care planning involves questions that may not come up in everyday life. Some decisions may take time to think through.
The conversations can also provide valuable information to the people around you.
A written document can record your choices. Conversations can help the people you trust understand what matters to you and the priorities behind those choices.
Review Your Advance Directives Over Time
Completing an advance directive does not mean you should put it away permanently and never think about it again.
NCOA recommends reviewing advance directives periodically to make sure they continue to reflect your wishes. Its guidance suggests making a habit of reviewing them annually.
Your health may change. You may receive a new diagnosis or learn more about a particular treatment. Your personal priorities may evolve as well.
Relationships can change too. If you have named someone to make healthcare decisions for you, you may eventually decide that another person would be a better choice.
A periodic review gives you an opportunity to consider whether your documents still reflect what you want.
If you make changes, think about who has copies of the previous version. The appropriate people should know that you updated your documents and how to locate the current ones.
What Can We Take Away From NCOA’s Guidance?
Advance care planning can begin well before a medical crisis occurs.
You can start while you are healthy. There is time to questions before you need the answers. You can also take time to think about difficult choices rather than trying to make every decision at once.
Creating an advance directive does not mean giving up your voice in your healthcare. It provides a way to document your preferences in case a time comes when you cannot communicate them yourself.
Once you have completed your documents, consider how they would be accessed if they were ever needed. The people who may rely on your advance directives should know that they exist and how to locate the current versions.
Legal Directives provides members with 24/7 access to stored healthcare directives through an Emergency Wallet Card. This can help make those documents available when they are needed, including during an unexpected medical emergency.
Requirements for advance directives vary by state. If you have questions about creating or updating your documents, consider speaking with an estate planning attorney who is familiar with the requirements where you live.
National Council on Aging, “Advance Directives: What Are They and When Should You Create One?” Read the full article here.