You may have heard the term advance directives when a loved one faced a serious medical illness, whether during the COVID-19 pandemic, a cancer diagnosis, or another significant health challenge. It is not a topic most people enjoy discussing, but it is one of the most important conversations you can have.
So what is advance directives? These are legal documents that share your medical treatment preferences ahead of time.
Just as we plan for many major events in life, it is also valuable to plan for future healthcare decisions. Planning does not mean expecting the worst. Rather, it means being prepared so that your wishes are known if you are too ill or too injured that you cannot speak for yourself.
Think about the preparation that often goes into welcoming a child into the world. Parents carefully plan for the baby’s arrival, and grandparents often make preparations for their new role as well. Advance care planning can be approached in a similar way—with thoughtfulness, care, and love for yourself and your family.
Depending on your culture, faith, beliefs, and personal experiences, this topic may bring comfort or discomfort. Some families find these discussions helpful and supportive while others may feel uneasy because they worry the conversation means something is wrong. For this reason, I encourage my patients to make advance care planning a routine part of their healthcare.
During your annual physical exam, consider discussing questions such as:
- What is most important to you regarding your health and quality of life?
- If you could not make medical decisions yourself, who would you trust to speak on your behalf?
- If your heart or breathing were to stop naturally, what would you want your healthcare team to do?
- Would you prefer care at home, in a hospital, or in a nursing facility if you became seriously ill?
The answers to these questions form the foundation of advance directives.
Each state has its own laws and forms related to advance directives. If discussing this topic feels challenging within your family, one helpful approach is to tell your loved ones that your physician recommended discussing advance care planning as part of your routine healthcare. This often reduces anxiety and helps family members understand that planning is a normal and responsible part of staying healthy.
Let’s review the major components of advance directives.
Health Care Proxy (Medical Power of Attorney)
A Health Care Proxy is a person you designate to represent/make medical decisions on your behalf if you are unable to do so yourself. You may also appoint an alternate person in case your primary choice is unavailable, unwilling, or unable to serve.
I believe this is one of the most important parts of advance care planning. I encourage my patients to review their choice yearly because circumstances and relationships can change over time. However, you can change this decision at any time if your relationship or circumstance changes.
Without a designated healthcare decision-maker, medical care may be delayed during times of crisis, and disagreements among family members can create additional stress. In some situations, the court may need to appoint someone to make decisions for you.
It is never too early to think about who you trust to fulfill this role. Equally important is sharing your wishes with that person. Some examples of wishes patients share include:
- “I do not want prolonged life support if there is no chance of meaningful recovery.”
- “Please focus on keeping me comfortable.”
- “I would like my family present whenever possible.”
- “I would prefer to remain at home rather than move to a nursing facility.”
There are no right or wrong answers. What matters most is that your healthcare proxy understands your values and goals.
In New York State, a Health Care Proxy can generally be completed without a lawyer or notary. Two adult witnesses are required, and the individuals you appoint as proxies cannot serve as witnesses.
If you are single, do not have children, or have limited family support, discussing this document with your physician may be especially important.
Living Will
A Living Will is a legal document that provides instructions about medical treatments you would or would not want under specific circumstances.
Topics commonly addressed include:
- Mechanical ventilation
- Cardiopulmonary resuscitation (CPR)
- Artificial nutrition and hydration
- Pain management
- Hospitalization
Many people prepare a Living Will with the assistance of an attorney. Even if you do not have a formal Living Will, discussing your wishes with your healthcare proxy and physician is extremely valuable.
Do Not Resuscitate (DNR)
A Do Not Resuscitate (DNR) order is a medical order signed by a licensed physician.
A DNR indicates that if your heart stops beating or you stop breathing, healthcare professionals will allow a natural death and will not attempt CPR.
Deciding whether a DNR is appropriate can be difficult. While no one can predict the future, your healthcare team can help you understand the potential benefits and limitations of CPR based on your medical condition.
Patients often consider a DNR when they have:
- A terminal illness
- Advanced chronic disease
- A desire to focus on comfort and quality of life
- Personal experiences witnessing prolonged life support without meaningful recovery
A DNR decision can be changed at any time if your wishes change.
Although this may not be a discussion that occurs every year, it is an important conversation to have when appropriate. For many patients and families, these discussions bring peace of mind and clarity rather than fear.
Medical Orders for Life-Sustaining Treatment (MOLST)
A Medical Orders for Life-Sustaining Treatment (MOLST) form is a physician’s medical order that translates your wishes into actionable medical instructions.
In New York State, the MOLST form allows patients and healthcare professionals to make decisions regarding:
- CPR or DNR status
- Mechanical ventilation
- Artificial hydration and nutrition
- Antibiotic use
- Pain management
- Hospitalization preferences
- Blood transfusions
- Dialysis
- Other life-sustaining treatments
Unlike a Living Will, a MOLST form is a medical order that healthcare professionals can follow immediately.
Final Thoughts
Advance directives are one of the greatest gifts you can give to your loved ones. They provide guidance during difficult times and help ensure that your healthcare reflects your personal values, beliefs, and goals.
These conversations are not about giving up hope. They are about maintaining your voice and your choices, even during times when you may be unable to speak for yourself.
If you have not yet discussed advance directives, consider bringing the topic up during your next annual physical exam. Planning ahead today can provide clarity, comfort, and peace of mind for both you and your family in the future.
