Let's face it. We never know when we might need medical care and treatment. For some people, deciding the issues and tackling the choices at the time care or treatment is needed is a sufficient way of handling matters. For many other people, there may be a desire to plan ahead of time through different types of advance directives.

Advance Directives

An advance directive is a document that is used to tell your physicians what kind of care you would like to have if you become unable to make medical decisions for yourself, such as if you are in a coma. Advance directives can provide direction on what you will allow your physicians to do in caring for you, and they can also state what types of treatment you would not like to have. In addition, they can declare that you want a certain type of treatment, no matter how ill you are.

Once a doctor receives a properly executed advance directive, he or she is under a duty to either honor its instructions or to transfer your care to a physician who will honor the instructions if he or she is unable or unwilling to do so.

• Living Wills

A living will is a type of advance directive that comes into effect, in some states, only when you are terminally ill. In other states, a living will may be called upon whenever you are unable to make decisions for yourself.

Note: In most situations, being terminally ill means that you have less than six months to live.

While a living will allows for you to describe in advance the kind of treatment you want to receive as your terminal condition progresses or while you are unable to make decisions for yourself, it does not allow for you to appoint a person to make medical decisions on your behalf.

Note: In some areas, a living will may be called a Directive to Physicians or a Healthcare Directive.

• Durable Power of Attorney for Health Care

A durable power of attorney for health care (or "healthcare proxy") is much like a living will. It allows you to make decisions as to what type of care you would like to receive in the future. A durable power of attorney for health care becomes active any time that you are either unconscious or unable to make medical decisions for yourself. In addition, with a durable power of attorney for health care, you can select a family member or friend to make medical decisions on your behalf if you are unable to make such decisions. You can give a person with a durable power of attorney as much power, or as little, as you wish and you can provide guidance to the decision-maker as to what types of treatment you would or would not prefer.

Example: Your durable power of attorney for health care can state that the designated person has the power to decide when treatment should be stopped. Or, you can state that the person only has the power to determine the types of treatments you receive, but cannot stop those treatments once they have begun.

• Make sure that the person you appoint will respect your wishes, although he or she may not agree with them. Make sure, also, that the person you appoint has a strong personality. He or she will need to be sensitive to the feelings of others who may not agree with your plans, but also assertive enough to carry out your wishes.

Note: In some states, you are prohibited from nominating certain people as your decision-maker. In most states, your doctor may not be able to be your decision-maker.

• If possible, an alternative decision-maker should be named in the document in case the primary decision-maker is unable to serve your interests because he or she becomes incompetent, dies or is otherwise unavailable.

• Do Not Resuscitate Orders

Do Not Resuscitate Orders, or DNRs, are advance requests not to have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. DNRs are important for individuals who do not want to have this potentially life-saving measure taken because, unless given contrary instructions, hospital staff will try to revive non-responding patients.

To create a DNR, you can either use an advance directive form or you can clearly tell your doctor that you do not wish to have CPR performed. In the former case, your doctor should make a conspicuous note in your medical chart. It is important, however, that a DNR created in this way be made at a time early in your hospitalization when your competency is not in question.

Benefits of Advance Directives

• With an advance directive, you may experience a sense of relief knowing that you will not be subjected to unnecessary or personally objectionable treatment.

• Without an advance directive, you may have to rely on the discretion of your physician to make decisions for you about your health care.

• Having an advance directive may save your loved ones anxiety, concern, and arguments.