JAMA PATIENT PAGE | Medical Decision Making

Advance Directives Advance directives help your family and your doctors respect your health care wishes. What Are Advance Directives? Advance directives are written instructions that you prepare to help guide your medical care. They apply in certain situations, such as if you are terminally ill or severely injured. Advance directives take effect when your doctor determines that you are no longer capable of making decisions about your own medical care. One common directive is a living will. In a living will, you define what medical treatments you want and do not want for yourself. These treatmentscanincludethingslikecardiopulmonaryresuscitation(CPR), mechanical ventilation (a “breathing machine”), medications, feeding tubes, artificial nutrition, dialysis, and intravenous (IV) fluids. Another common directive is naming a medical power of attorney (sometimes called a health care proxy or agent). This involves choosing someone you trust to make decisions about your medical care if you cannot make those decisions.

Advance Directives and the Law Advance directives are not legally binding. A doctor or institution can refuse to honor your advance directives for moral or religious reasons or if the care you request is not medically appropriate. In many states, adoctororfacilitythatrefusestohonoranadvancedirectivemustmake an effort to transfer care to another doctor or facility. Talking with your doctor before you become seriously ill may help avoid these situations.

Who Should Have Advance Directives? Advance directives are not just for elderly or very sick patients. Every adult should prepare advance directives. If you are a young or middleaged adult and you suddenly become severely ill or injured, your family may have to make difficult decisions about your care. Advance directivescanhelpmakethosedecisionseasier.Yourlovedoneswillknow that you are receiving the medical care you would want for yourself.

How Are Advance Directives Prepared? Start by thinking about your health care goals and values. Consider what is important to you about your medical care if you become seriously ill. Talk with your family and your doctor. Some websites offer workbooks to help you get started with advance care planning. The required forms for advance directives vary from state to state. Each state’s forms are available for free online. You do not need a lawyer to complete advance directives. Most states require the signatures of at least 2 witnesses. Keep these documents in a safe place, but be sure your loved ones have access to them. You can also give Author: Amy E. Thompson, MD Sources: American Bar Association, National Hospice and Palliative Care Organization


copies to your doctor or hospital. There are websites and smartphone apps that let you create and store digital copies of advance directives, usually for a fee. You should review your advance directives regularly, and you can update them at any time. Even after you prepare advance directives, continue to talk with your loved ones and your doctor about your goals and wishes for your health care.


• Center for Practical Bioethics www.cpbmembers.org/documents/Caring-Conversations.pdf • National Hospice and Palliative Care Organization www.caringinfo.org/files/public/brochures/Understanding_Advance _Directives.pdf www.caringinfo.org/i4a/pages/index.cfm?pageid=3289 To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA’s website at jama.com. Many are available in English and Spanish.

The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.

JAMA February 24, 2015 Volume 313, Number 8 (Reprinted)

Copyright 2015 American Medical Association. All rights reserved.

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