Advance Directive

Following Your Healthcare Wishes

Advance Directives and Durable Power of Attorney for Healthcare – Download

An Advance Directive:

  • Tells your doctors and other healthcare workers what types of care you would like to have if you are not able to make your own medical decisions.
  • Allows you to appoint a Patient Advocate who can make medical decisions for you if you are unable to make medical decisions for yourself.
  • Protects you as the patient and protects the people who care for you.

To activate the advance directive, two doctors or a doctor and a psychologist would sign an additional form to say you no longer have the capacity to make your own healthcare decisions.

If you do not choose an Advocate:

If you are too sick to make your own decisions and have not completed an advance directive, your doctors will ask your closest family members to make decisions for you. If your family members cannot make decisions for you or you need further care, then a judge may appoint someone to make decisions for you. There will likely be court/attorney fees associated with this which your family may be responsible for.

After the form is completed keep the original at home in a safe place. Share a copy of all five pages of the document with:

  • Your Patient Advocate(s)
  • Doctors
  • Local hospital

An Advance Directive is used when:

You are unable to make your own decisions. Your plan in your advance directive would be a guide for your advocate to follow. As long as you are capable of making your own decisions, you remain in control of your own medical care.

If you change your mind:

Complete a new form and provide copies to everyone listed above.

If your Advocate has a name change, phone number or address change:

Write/Type on a separate sheet of paper the updated information, attach it to your original document, and provide copies to everyone listed above.

If you want to make health care decisions that are not on the form:

Write your choices on a piece of paper and keep the paper with this form.

You should review the form:

  • Every 10 years.
  • Every time you have a change in your health status.
  • When you have a change in your home situation (example: new marriage, advocate’s death).

If you have questions when completing the form:

  • Bring it to your doctors, nurses, or social workers to answer your questions.
  • You also have a right to see an attorney to complete this form.

Things to consider when completing form/Discussions to have with your Advocate:

  • You have suffered a stroke and are alert, but can’t communicate or care for yourself. If being fed by a spoon is no longer possible, do you want to be fed through a tube?
  • You have dementia and live with family but don’t recognize them anymore. Family has hired someone to stay with you while they work and the cost is hard on the family. You’ve been in the hospital with pneumonia three times this year. The next time you get pneumonia, do you want antibiotics for treatment or to be kept comfortable for end of life care?
  • You are in a coma after a severe car accident. Your doctors do not think you will get better. Would you want to be on a long term ventilator far from your family, or would you like to be kept comfortable near your family for the rest of your life?

Please be sure to complete the document correctly. It must be witnessed:

  • Hospital employees, your Doctor, and Doctor’s office staff cannot be witnesses.
  • Witnesses cannot be your immediate relatives (spouse, parent, child, grandparent, or sibling).
  • You MUST sign document in front of two witnesses at the same time to make it a legal document. You and both witnesses need to all write the same date.
  • Suggestions of where to find witnesses – example: bank, neighbors, church, work.