The best time to consider advance directives is when you are in good health. This gives you the opportunity to fully express your wishes in a clear state of mind. There is only one person truly qualified to tell your health care providers how you feel about different issues—and that’s YOU.
Some people believe that doctors know best and therefore should make all the decisions. However, patients' values and goals are very important and should be the guiding force behind your care. Your health care providers have technical knowledge and years of experience, but without your help, they can't know what's best for you given your specific medical situation. Two patients with the same condition can have very different ideas about what kind of treatment they want. Have you thought about what kinds of medical care you would choose if you couldn’t tell your providers what you wanted? Through advance care planning, you can help ensure that your wishes will guide future care.
about what you would want if you had to make difficult choices.
about your views with your spokesperson, loved ones, and health care providers.
a spokesperson who can speak for you if you can't speak for yourself.
an advance directive to document your preferences.
Grace Chen was 35 years old when she was hit by a car while riding her bicycle. She was taken to the hospital, where she went into a coma. She lay in bed with her eyes closed. She didn’t respond when people spoke to her and she didn’t wake up. She also couldn’t breathe or eat on her own. Grace was put on a ventilator, or breathing machine, that pumped air into her lungs. She also had a feeding tube in her throat so that liquid food and fluids could go straight into her stomach.
Grace was single, so her doctors asked her parents to decide about his treatments. The doctors thought it was possible that Grace could come out of the coma. But they said that it could take anywhere from one week to one year. They said that the longer Grace stayed in a coma, the less likely it was that she would ever wake up. And if she did come out of the coma, they said, she would probably have some brain damage. The damage could be mild or it could be severe. Grace might need help taking care of herself and might not be able to live alone.
Grace had never said what she would want if she were in an accident. After two months, Grace was still unconscious. A brain scan showed severe injury to many parts of her brain. The doctors thought this gave Grace a very low chance of ever waking up.
If you were in Grace’s situation, what would you want your parents to do? Why?
SGT Larsen is a 22-year-old patient. While serving in combat, he was severely injured in an explosion. The explosion caused brain damage and left him unable to communicate. Doctors didn’t know how much his brain would recover. The explosion also damaged his spinal cord, leaving him paralyzed from the waist down. The paralysis would be permanent
Since SGT Larsen couldn’t communicate his own medical decisions, the doctors asked his family. His parents told the doctors to “do everything possible” to keep him alive, regardless of his chances for recovery. They believed their son shared their views on the value of life.
However, SGT Larsen’s sister was against using technology that might add to her brother’s suffering, even if it kept him alive. She believed that he wouldn’t want to live after being injured so severely. She had spoken with him before he went into combat. He told her his greatest fear was getting injured so severely that he would be unable to do the things he loved most.
The doctors followed the directions from his parents because his parents were the legal next of kin. After several months, SGT Larsen’s condition stabilized enough that his parents could care for him at home. Sadly, the disagreement in the family caused hard feelings that lasted for many years.
A Durable Power of Attorney for Health Care document tells your health care providers who you want to make medical decisions for you if you get too sick to decide for yourself. It is included in most advance directive forms.
Do you want to appoint a spokesperson but aren't sure who that should be? The Choosing a Spokesperson worksheet can help you identify a competent adult who you feel would act upon your wishes.Start Worksheet
To appoint a spokesperson and complete an advance directive, choose a legal document in your state from the list below. (Please enable popups for this link to work.)
For help identifying, thinking about, and expressing your personal wishes.Start Worksheet