Advance directives put you in control of your care
DEAR DOCTOR K:
I've been very ill and have been hospitalized several times in the past year. I don't have a fatal disease, just a chronic illness. Should I have an advance directive? Can you tell me about it?
What if you suddenly get very sick, due to accident or illness, and cannot communicate what type of medical care you want to receive? Advance directives are legally binding documents that allow you to control how you are treated if and when you can't speak for yourself.
As long as you are able to make and communicate decisions, your word overrides any advance directive. These documents take effect only when you're unconscious or too ill to make your wishes known.
The most common misconception my patients have about advanced directives is that they will lose control over the medical care they receive. I explain that the opposite is true: The advance directive is the way you gain control over the medical care you receive.
Advance directives include three parts: the health-care power of attorney, living will and do-not-resuscitate order (DNR). You may wish to have any or all of them.
A health-care power of attorney permits you to name a health-care agent (proxy) to make medical decisions on your behalf. I strongly urge all my patients to do that. Why? Because if you don't, then you will lose control of who speaks for you. The doctor may ask several close relatives to come to a consensus. Conflicts may ensue and decisions may be delayed. Some of my patients stop there, trusting that the person to whom they have given power of attorney will know what they want done if they cannot speak for themselves.
A living will allows you to describe your goals for medical treatment. A do-not-resuscitate order (DNR) specifies that you don't wish to be revived if your heart or breathing stops. Without a DNR, people treating you must assume that you consent to treatment.
The key element of a living will and of a DNR order is distinguishing those various different circumstances that may apply when you are unable to speak for yourself.
You can be very sick and still have a good chance of recovery, or a slim chance of recovery. You may have a good chance of recovering with a high level of function, or it may be likely you will have only a very low level of function. You may be 50 or you may be 90. You may have family and friends or you may be alone in the world. You might want to be treated differently given different combinations of these circumstances.
We have more information on advance directives in our Special Health Report, "The Health Care Power of Attorney and Living Will." (Learn more about this report at AskDoctorK.com, or call 877-649-9457 toll-free to order it.)
(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)
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