Advance Directives

An advance directive allows a capable adult to record treatment preferences and/or name another person to make health care decisions if the patient later loses decision-making capacity. It protects autonomy across time: the patient’s previously expressed choices can guide care even when illness, injury, delirium, or neurologic decline prevents the patient from speaking for themself. The two common forms are: - Living will or instructional directive: describes treatments the patient would or would not want in specified circumstances, such as CPR, mechanical ventilation, artificial nutrition, dialysis, or other life-sustaining interventions. - Durable power of attorney for health care or health care proxy: names an agent who can make decisions when the patient cannot. The document may be called something different in a particular state. A directive is not automatically a medical order. It gives the clinical team and the agent guidance, but a provider may still need to enter specific orders for CPR, intubation, hospitalization, or other interventions. State law determines how a document must be executed, when it becomes operative, and how an agent or default surrogate is recognized....